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Hyperfiltration in Critically Ill Older Adults: Incidence, Risk Factors, Time Course, and Predictive Performance of

Ryusei Mikami1,2, Shungo Imai3, Mineji Hayakawa4

  • 1Graduate School of Life Science, Hokkaido University, Sapporo, Japan.

Pharmacotherapy
|May 11, 2026
PubMed
Summary

Hyperfiltration is common in critically ill older adults, affecting 56% of patients. The Cockcroft-Gault equation significantly underestimates kidney function in these patients, risking incorrect medication dosing.

Keywords:
hyperfiltrationintensive care unitolder adults

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Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Geriatrics

Background:

  • Hyperfiltration, an elevated glomerular filtration rate, is increasingly recognized in critically ill patients.
  • Estimating kidney function accurately is crucial for medication management and patient outcomes in the intensive care unit (ICU).

Purpose of the Study:

  • To determine the incidence, risk factors, and time course of hyperfiltration in critically ill older adults.
  • To evaluate the predictive performance of the Cockcroft-Gault equation for estimating kidney function in this population.

Main Methods:

  • Retrospective observational study of 325 critically ill older adults (median age 76 years).
  • Hyperfiltration defined as measured creatinine clearance (Clcr) > -0.883 × age + 167.398.
  • Analysis of risk factors using multivariable logistic regression and assessment of Cockcroft-Gault equation performance via bias and accuracy (P30).

Main Results:

  • Hyperfiltration occurred in 56% of patients, with onset around day 5 and duration of 8 days.
  • Risk factors included male sex, high BMI, trauma, vasopressor use, and low serum creatinine.
  • The Cockcroft-Gault equation significantly underestimated measured Clcr, with substantial bias and low accuracy (P30), particularly in patients meeting augmented renal clearance (ARC) criteria.

Conclusions:

  • Hyperfiltration is highly prevalent in critically ill older adults.
  • The Cockcroft-Gault equation is unreliable for estimating kidney function in this group, leading to potential underestimation of actual kidney function.
  • Continuous monitoring of measured Clcr is recommended to guide medication dosing and avoid inappropriate dose reductions.