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Comparison of Cysta...
Comparison of Cystatin C and Creatinine in the Assessment of Measured Kidney Function during Critical Illness
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- Haines, Ryan W (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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- Fowler, Alex J (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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- Liang, Kaifeng (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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- Pearse, Rupert M (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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- Larsson, Anders O (författare)
- Uppsala universitet,Klinisk kemi
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- Puthucheary, Zudin (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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- Prowle, John R (författare)
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BB, UK
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(creator_code:org_t)
- 2023
- 2023
- Engelska.
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Ingår i: American Society of Nephrology. Clinical Journal. - : Ovid Technologies (Wolters Kluwer Health). - 1555-9041 .- 1555-905X. ; 18:8, s. 997-1005
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.2...
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Abstract
Ämnesord
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- Background: Incomplete recovery of kidney function is an important adverse outcome in survivors of critical illness. However, unlike eGFR creatinine, eGFR cystatin C is not confounded by muscle loss and may improve identification of persistent kidney dysfunction.Methods: To assess kidney function during prolonged critical illness we enrolled 38 mechanically ventilated patients with expected length of stay of >72h near admission to ICU in a single academic medical center. We assessed sequential kidney function using creatinine, cystatin C, and iohexol clearance measurements. The primary outcome was difference between eGFR creatinine and eGFR cystatin C at ICU discharge using Bayesian regression modelling. We simultaneously measured muscle mass by ultrasound of rectus femoris to assess the confounding effect on serum creatinine generation.Results: Longer length of ICU stay was associated with greater difference between eGFR creatinine and eGFR cystatin C at a predicted rate of 2 ml/min/1.73m2/day (95% confidence interval 1-2). By ICU discharge the posterior mean difference between creatinine and cystatin C eGFR was 33 ml/min/1.73m2 (95% credible interval 24-42). In 27 patients with iohexol clearance measured close to ICU discharge, eGFR creatinine was on average 2-fold greater than the iohexol gold-standard, posterior mean difference 59 ml/min/1.73m2 (95% credible interval 49-69). The posterior mean for eGFR cystatin C suggested a 22 ml/min/1.73m2 (95% credible interval 13-31) overestimation of measured GFR. Each day in ICU resulted in a predicted 2% (95%CI 1-3%) decrease in muscle area. Change in creatinine-to-cystatin C ratio showed good longitudinal, repeated measures correlation with muscle loss, R=0.61 (95% confidence interval, 0.50-0.72).Conclusions: eGFR creatinine systematically over-estimated kidney function after prolonged critical illness. Cystatin C better estimated true kidney function as it appeared unaffected by the muscle loss of prolonged critical illness.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
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