Estimated Glomerular Filtration Rates Are Higher when Creatinine-based Equations Are Compared with a Cystatin C-based Equation in Coronavirus Disease 2019

Overview

Journal Acta Anaesthesiol Scand

Specialty Anesthesiology

Date 2022 Nov 18

PMID 36400740

Authors

Anders O Larsson

Michael Hultstrom

Robert Frithiof

Miklos Lipcsey

Ulf Nyman

Mats B Eriksson

Affiliations

Soon will be listed here.

Abstract

Objectives: Estimations of glomerular filtration rate (eGFR) are based on analyses of creatinine and cystatin C, respectively. Coronavirus disease 2019 (COVID-19) patients in the intensive care unit (ICU) often have acute kidney injury (AKI) and are at increased risk of drug-induced kidney injury. The aim of this study was to compare creatinine-based eGFR equations to cystatin C-based eGFR in ICU patients with COVID-19.

Methods: After informed consent, we included 370 adult ICU patients with COVID-19. Creatinine and cystatin C were analyzed at admission to the ICU as part of the routine care. Creatinine-based eGFR (ml/min) was calculated using the following equations, developed in chronological order; the Cockcroft-Gault (C-G), Modified Diet in Renal Disease (MDRD)1999, MDRD 2006, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Lund-Malmö revised (LMR) equations, which were compared with eGFR calculated using the cystatin C-based Caucasian Asian Pediatric Adult (CAPA) equation.

Results: The median eGFR when determined by C-G was 99 ml/min and interquartile range (IQR: 67 ml/min). Corresponding estimations for MDRD1999 were 90 ml/min (IQR: 54); MDRD2006: 85 ml/min (IQR: 51); CKD-EPI: 91 ml/min (IQR: 47); and for LMR 83 ml/min (IQR: 41). eGFR was calculated using cystatin C and the CAPA equation value was 70 ml/min (IQR: 38). All differences between creatinine-based eGFR versus cystatin C-based eGFR were significant (p < .00001).

Conclusions: Estimation of GFR based on various analyses of creatinine are higher when compared with a cystatin C-based equation. The C-G equation had the worst performance and should not be used in combination with modern creatinine analysis methods for determination of drug dosage in COVID-19 patients.

Citing Articles

Shrunken Pore Syndrome Is Frequently Occurring in Severe COVID-19.

Larsson A, Hultstrom M, Frithiof R, Lipcsey M, Eriksson M Int J Mol Sci. 2022; 23(24).

PMID: 36555328 PMC: 9779236. DOI: 10.3390/ijms232415687.

Estimated glomerular filtration rates are higher when creatinine-based equations are compared with a cystatin C-based equation in coronavirus disease 2019.

Larsson A, Hultstrom M, Frithiof R, Lipcsey M, Nyman U, Eriksson M Acta Anaesthesiol Scand. 2022; 67(2):213-220.

PMID: 36400740 PMC: 10099776. DOI: 10.1111/aas.14173.

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