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. 2020;144(7):313-320.
doi: 10.1159/000507255. Epub 2020 May 19.

Predictors of Augmented Renal Clearance in a Heterogeneous ICU Population as Defined by Creatinine and Cystatin C

Andrea M Nei  1 , Kianoush B Kashani  2   3 , Ross Dierkhising  4 , Erin F Barreto  5   6
Affiliations

Predictors of Augmented Renal Clearance in a Heterogeneous ICU Population as Defined by Creatinine and Cystatin C

Andrea M Nei et al. Nephron. 2020.

Abstract

Introduction: The incidence of augmented renal clearance (ARC) in the intensive care unit (ICU) is highly variable, and identification of these patients remains challenging.

Objective: The objective of this study was to define the incidence of ARC in a cohort of critically ill adults, using serum Cr and cystatin C, and to identify factors associated with its development.

Methods: This is a retrospective cohort study of critically ill patients without stage 2 or 3 acute kidney injury with both serum Cr and cystatin C available. The incidence of ARC was defined as a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)Cr-cystatin C-estimated glomerular filtration rate >130 mL/min. A multivariable logistic regression model using a penalized Lasso method was fit to identify independent predictors of ARC.

Results: Among the 368 patients included in the study, indication for ICU admission was nonoperative in 55% of patients, and 9% of patients were admitted for major trauma. The overall incidence of ARC was low at 4.1%. In a multivariable logistic regression model, Charlson comorbidity index, major trauma, intracerebral hemorrhage, age, and Sequential Organ Failure Assessment score were found to predict ARC.

Conclusion: The incidence of ARC in this study was low, but prediction models identified several factors for early identification of patients with risk factors for or who develop ARC, particularly in a cohort with a low baseline risk of ARC. These factors could be used to help identify patients who may develop ARC.

Keywords: Augmented renal clearance; Biomarker; Critical care; Cystatin C; Nephrology.

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Figures

Figure 1.
Figure 1.
Consort Diagram for Study Inclusion. A total of 368 patients were included in the study analysis, 15 with augmented renal clearance (ARC) and 353 without ARC.
Figure 2.
Figure 2.
Incidence of Augmented Renal Clearance (ARC). The incidence of ARC varied depending on the eGFR equation used; CKD-EPICreatinine 29 patients (7.9%) , CKD-EPICystatin C 12 (3.3%), CKD-EPICreatinine-Cystatin C 15 (4.1%).
Figure 3.
Figure 3.
ROC Analysis. Multivariable model performance for prediction of augmented renal clearance (ARC) [AUC of 0.95 (95% CI 0.92–1)], in a population at low risk for ARC.
See this image and copyright information in PMC

References

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