The aim of this study was to determine whether creatinine clearance can be estimated as well by clearance of gentamicin/tobramycin as by routine, non-invasive estimates in the intensive care unit.
The volume of distribution and clearance values for gentamicin I tobramycin were obtained using first order kinetics and an estimate of creatinine clearance derived. Seven estimates of renal function (Cockroft-Gault, MDRD4 and MDRD6 equations, two- and 24-hour urine estimates, two equations utilising Cystatin C concentrations) were compared to the gentamicin/tobramycin clearance estimate in 100 intensive care unit patients.
The gentamicin clearance estimate was at least as reliable as other estimates. The two-hour was less reliable than the 24-hour urine estimate. The Cockroft-Gault appeared to out-perform the MDRD equation estimates. The MDRD4 was not as reliable as the MDRD6 estimate. Cystatin C estimates appeared not as reliable as the gentamicin estimate of renal function.
The gentamicin/tobramycin estimate is at least as good as other estimates and it is available sooner than most others. It should be used in all patients who are prescribed gentamicin. The two-hour urine and MDRD4 estimates should not be used in the intensive care unit.
CockroftD.W., GaultM.H.Prediction of creatinine clearance from serum creatinine. Nephron1976; 16: 31–41.
2.
LeveyA.S., BoschJ.P., LewisJ.B., GreeneT., RogersN., RothD.A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med1999; 130: 461–470.
3.
LeveyA.S., GreeneT., KusekJ.W.A simplified equation to predict glomerular filtration rate from serum creatinine. (Abstract). J Am Soc Nephrol2000; 11: A0828.
4.
ReidenbergM.M.Kidney function and drug action. N Engl J Med1985; 313: 816–818.
5.
le RicheM., ZernlinA.E., ErasmusR.T., DavidsM.R.An audit of 24-hour creatinine clearance measurements at Tygerberg Hospital and comparison with prediction equations. S Afr Med J2007; 97: 968–970.
6.
RobertS., ZarowitzB.J., PetersonE.L., DumlerE.Predictability of creatinine clearance estimates in critically ill patients. Crit Care Med1993; 21: 1487–1495.
7.
WilsonR.F., SoullierG.The validity of two-hour creatinine clearance studies in critically ill patients. Crit Care Med1980; 8: 281–284.
8.
CherryR.A., EachempatiS.R., HydoL., BarieP.S.Accuracy of short-duration creatinine clearance determinations in predicting 24-hour creatinine clearance in critically ill and injured patients. J Trauma2002; 53: 267–271.
9.
ZarowitzB.J., RobertS., PetersonE.L.Prediction of glomerular filtration rate using aminoglycoside clearance in critically ill medical patients. Ann Pharmacother1992; 26: 1205–1210.
10.
PesolaG.R., AkhavanI., MaduA., ShahN.K., CarlonG.C.Prediction equation estimates of creatinine clearance in the intensive care unit. Intensive Care Med1993; 19: 39–43.
11.
LimW.H., McDonaldS.Lean body mass-adjusted Cockroft and Gault formula improves the estimation of glomerular filtration rate in subjects with normal-range serum creatinine. Nephrology2006; 11: 250–256.
12.
BuijkS.E., MoutonJ.W., GyssensI.C., VerbrughH.A., BruiningH.A.Experience with a once-daily dosing program of aminoglycosides in critically ill patients. Intensive Care Med2002; 28: 936–942.
13.
MathewT.H., JohnsonD.W., JonesGRD; Australasian Creatinine Consensus Working Group Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. Med J Aust2007; 187: 459–463.
14.
MathewTH; Australasian Creatinine Consensus Working Group. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement. Med J Aust2005; 183: 138–141.
15.
Du BoisD., DuBoisE.F.A formula to estimate the approximate surface area if height and weight be known. Arch Int Med1916; 1: 863–871.
16.
FillerG., BokenkampA., HofmannW., Le BriconT., Martinez-BruC., GrubbA.Cystatin C as a marker of GFR – history, indications, and future research. Clin Biochem2005; 38: 1–8.
17.
GrubbA., NymanU., BjorkJ., LindstromV., RippeB., SternerG.Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem2005; 51: 1420–1431.
18.
Herget-RosenthalS., BokenkampA., HofmanW.How to estimate GFR-serum creatinine, serum cystatin C or equations. Clin Biochem2007; 40: 153–161.
19.
KnightE.L., VerhaveJ.C., SpiegelmanD., HillegeH.L., de ZeeuwD., CurhanG.C.Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int2004; 65: 1416–1421.
20.
DeeterR.G., KraussE.A., PennF., NahaczewskiA.E.Comparison of aminoglycoside clearance and calculated serum creatinine clearances. Ther Drug Monit1989; 11: 155–161.
21.
NakahiroR.K., OkamotoM.P., ChinA., GillM.A., ChaeJ.S., SclarD.A.Use of gentamicin clearance in estimating renal function. Clin Pharm1992; 10: 931–934.
22.
HicklingK.G., BeggEl, PerryR.E., AtkinsonH.C., SharmanJ.R.Serum aminoglycoside clearance is predicted as poorly by renal aminoglycoside clearance as by creatinine clearance in critically ill patients. Crit Care Med1991; 19: 1041–1047.
23.
LarssonA., MalmJ., GrubbA., HanssonL.O.Calculation of glomerular filtration rate expressed in mlL/min from plasma cystatin C values in mg/1. Scand J Clin Lab Invest2004; 64: 25–30.
24.
BostomA.G., KronenbergF., RitzE.Predictive performance of renal function equations for patients with chronic kidney disease and normal serum creatinine levels. J Am Soc Nephrol2002; 13: 2140–2144.
25.
MariatC., AlamartineE., BarthelemyJ-C, De FilippisJ-P, ThibaudinD., BerthouxP.Assessing renal graft function in clinical trials: can tests predicting glomerular filtration rate substitute for a reference method?Kidney Int2004; 65: 289–297.
26.
LinJ., KnightE.L., HoganM.L., SinghA.K.A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Ant Soc Nephrol2003; 14: 2573–2580.
27.
CoreshJ., TotoR.D., KirkK.A., WheltonP.K., MassryS., JonesC.Creatinine clearance as a measure of GFR in screenees for the African-American Study of Kidney Disease and Hypertension pilot study. Am J Kidney Dis1998; 32: 32–42.
28.
HassanE., OberJ.D.Predicted and measured aminoglycoside pharmacokinetic parameters in critically ill patients. Antimicrob Agents Chemother1987; 31: 1855–1858.
29.
MannH.J., FuhsD.W., AwangR., NdemoF.A., CerraF.B.Altered aminoglycoside pharmacokinetics in critically ill patients with sepsis. Clin Pharm1987; 6: 148–153.
30.
DormanT., SwobodaS., ZarfeshenfardF., TrentlerB., LipsettP.A.Impact of altered aminoglycoside volume of distribution on the adequacy of a three milligram per kilogram loading dose. Critical Care Research Group. Surgery1998; 124: 73–78.
31.
BeckhouseM.J., WhyteI.M., BythP.L., NapierJ.C., SmithA.J.Altered aminoglycoside pharmacokinetics in the critically ill. Anaesth Intensive Care1989; 16: 418–422.
32.
MarikP.E.Aminoglycoside volume of distribution and illness severity in critically ill septic patients. Anaesth Intensive Care1993; 21: 172–173.
33.
DemczarD.J., NafzigerA.N., BertinoJSJr.Pharmacokinetics of gentamicin at traditional versus high doses: implications for once-daily aminoglycoside dosing. Antimicrob Agents Chemother1997; 41: 1115–1119.
34.
McNamaraD.R., NafzigerA.N., MenhinickA.M., BertinoJSJr.A dose-ranging study of gentamicin pharmacokinetics: implications for extended interval aminoglycoside therapy. J Clin Pharmacol2001; 41: 374–377.
35.
WallaceA.W., JonesM., BertinoJ.S.Evaluation of four once-daily aminoglycoside dosing nomograms. Pharmacotherapy2002; 22: 1077–1083.
