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Clin J Am Soc Nephrol. 2012 May;7(5):712-9. doi: 10.2215/CJN.10821011. Epub 2012 Mar 15.

Estimating baseline kidney function in hospitalized patients with impaired kidney function.

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  • 1Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA. edward.siew@vanderbilt.edu

Abstract

BACKGROUND AND OBJECTIVES:

Inaccurate determination of baseline kidney function can misclassify acute kidney injury (AKI) and affect the study of AKI-related outcomes. No consensus exists on how to optimally determine baseline kidney function when multiple preadmission creatinine measurements are available.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The accuracy of commonly used methods for estimating baseline serum creatinine was compared with that of a reference standard adjudicated by a panel of board-certified nephrologists in 379 patients with AKI or CKD admitted to a tertiary referral center.

RESULTS:

Agreement between estimating methods and the reference standard was highest when using creatinine values measured 7-365 days before admission. During this interval, the intraclass correlation coefficient (ICC) for the mean outpatient serum creatinine level (0.91 [95% confidence interval (CI), 0.88-0.92]) was higher than the most recent outpatient (ICC, 0.84 [95% CI, 0.80-0.88]; P<0.001) and the nadir outpatient (ICC, 0.83 [95% CI, 0.76-0.87; P<0.001) serum creatinine. Using the final creatinine value from a prior inpatient admission increased the ICC of the most recent outpatient creatinine method (0.88 [95% CI, 0.85-0.91]). Performance of all methods declined or was unchanged when the time interval was broadened to 2 years or included serum creatinine measured within a week of admission.

CONCLUSIONS:

The mean outpatient serum creatinine measured within a year of hospitalization most closely approximates nephrologist-adjudicated serum creatinine values.

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