- Poster presentation
- Open access
- Published:
Use of 2-hourly creatinine clearance to inform cessation of renal replacement therapy
Critical Care volume 15, Article number: P130 (2011)
Introduction
Acute kidney injury (AKI) is a common problem in critically ill patients, with a reported incidence of 1 to 25% and a poor prognosis. Although optimal dosing of renal replacement therapy (RRT) is relatively well understood, appropriate timing of commencing and ceasing RRT in patients with AKI has been under debate for a long time. From the viewpoint of an early renal support strategy, the goal of early RRT is to maintain solute clearance and fluid balance to prevent subsequent multiorgan damage, while waiting for the recovery of renal function. It has previously been noted that 2-hourly creatinine clearance accurately reflects the more cumbersome 24-hour value [1]. The aim of the present study was to evaluate whether routine measurement of creatinine clearance (CrCl) could help to predict when to cease dialysis, and determine what value for CrCl best predicted remaining dialysis-free in critically ill patients receiving CRRT.
Methods
Two-hourly creatinine clearance is calculated daily on most patients on CRRT in our ICU. If CrCl is greater than 20 ml/minute, CRRT is ceased. Our retrospective chart review examined records for all patients admitted to our ICU in 2008 and determined whether a CrCl greater than 20 ml/minute accurately predicted remaining dialysis-free 5 days later.
Results
Forty-one patients were suitable for analysis. Of these, 12 (30%) never reached CrCl >20 ml/minute and remained on dialysis leaving the ICU. Of the remaining 29 patients, in 23 (79%) having a CrCl >20 ml/minute meant they remained dialysis-free for at least the following 5 days. Six patients (21%), despite having a CrCl >20 ml/minute, resumed dialysis within 5 days for metabolic or fluid-removal reasons.
Conclusions
Although this is a small retrospective study it suggests that 2-hourly creatinine clearance values may accurately predict when CRRT should be discontinued. These pilot results should be used to inform a larger prospective study.
References
Herrera-Gutiérrez ME, Seller-Pérez G, Banderas-Bravo E, et al.: Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study. Intensive Care Med 2007, 33: 1900-1906.
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Solymos, O., Frohlich, S. & Conlon, N. Use of 2-hourly creatinine clearance to inform cessation of renal replacement therapy. Crit Care 15 (Suppl 1), P130 (2011). https://doi.org/10.1186/cc9550
Published:
DOI: https://doi.org/10.1186/cc9550