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Creatinine clearance predictions in acutely ill patients
American Journal of Hospital Pharmacy
|June 1, 1981
Summary
The Siersbaek-Nielsen nomogram (SNN) overestimates creatinine clearance (Clcr) in critically ill patients, especially those with low urinary creatinine excretion. Adjustments to SNN predictions are necessary for accurate Clcr estimation in this population.
Area of Science:
- Pharmacokinetics
- Nephrology
- Critical Care Medicine
Background:
- Accurate estimation of creatinine clearance (Clcr) is crucial for drug dosing in acutely ill patients.
- The Siersbaek-Nielsen nomogram (SNN) is a commonly used tool for predicting Clcr, often utilizing ideal body weight (IBW).
Purpose of the Study:
- To compare predicted Clcr using SNN with actual Clcr in critically ill patients.
- To evaluate the accuracy of SNN in different urinary creatinine excretion (Ucr) groups and patient subgroups.
Main Methods:
- Collected timed urine samples (8-24 hours) from 118 critically ill patients undergoing aminoglycoside therapy.
- Calculated actual Clcr from measured urine creatinine and compared it with SNN-predicted Clcr using IBW and actual body weight (ABW).
- Stratified patients based on low, normal, and elevated Ucr levels.
Main Results:
- SNN most accurately predicted Clcr in patients with normal Ucr (20% of collections).
- Most patients exhibited significantly lower Ucr than the reference population.
- SNN overpredicted Clcr by 10-20 ml/min in patients with low Ucr and in obese patients.
Conclusions:
- The SNN nomogram requires adjustments for accurate Clcr prediction in critically ill patients, particularly those with low Ucr.
- Further research is needed to understand the characteristics and mechanisms of low Ucr in this population.
- Using IBW, rather than ABW, improved SNN accuracy in obese critically ill patients.