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Bioelectrical Impedance Measurements for Assessment of Kidney Function in Critically Ill Patients

de Jong, Lutea A. A. PharmD, PhD1; Otten – Helmers, Annemiek G. MSc1; Spronk, Peter E. MD, PhD2; van Kan, Hendrikus J. M. PharmD, PhD1

doi: 10.1097/CCM.0000000000004033
Online Clinical Investigations
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Objectives: To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease, and Jelliffe’s.

Design: An open-label prospective observational cohort study.

Setting: A 12-bed ICU at a nonuniversity major teaching hospital (Gelre ziekenhuizen Apeldoorn/Zutphen, The Netherlands).

Patients: Adult critical care patients with an expected ICU length of stay at admission of at least 48 hours.

Interventions: Each patient’s body composition was assessed using a validated Quadscan 4000 analyzer (Bodystat, Isle of Man, British Isles). Twenty-four hours urine was collected, and laboratory variables in serum including creatinine, urea, and albumin were obtained at the beginning and end of the collection period.

Measurements and Main Results: A total of 151 patients, stratified to an acute and nonacute ICU-group, were enrolled in the study over a 2-year period. A formula to predict creatinine/urea clearance based on 24 hours urine collection was developed using stepwise linear regression using a training data set of 75 patients. This formula was subsequently tested and compared with other relevant predictive equations using a validation data set of 76 patients. Serum creatinine values ranged from 40 to 446 µmol/L. With the predictive model based on estimated body cell mass and a “prediction marker” more than 71% of the observed variance in creatinine/urea clearance based on 24 hours urine collection could be explained. Predictive performance was superior to the other eight evaluated models (R2 = 0.39–0.55) and demonstrated to be constant over the whole range of creatinine/urea clearance based on 24 hours urine collection values.

Conclusions: Multifrequency bioelectrical impedance analysis measurements can be used to predict creatinine/urea clearance based on 24 hours urine collection with superior performance than currently established prediction models. This rapid, noninvasive method enables correction for influences of a patient’s actual body composition and may prove valuable in daily clinical practice.

1Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn, The Netherlands.

2Department of Intensive Care, Gelre Hospitals, Apeldoorn, The Netherlands.

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The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: l.van.gendt@gelre.nl

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