Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients:: a single-center study

Objective: To estimate the usefulness of 2-h creatinine clearance (CrCl) in the ICU and define variables that may reduce agreement. Design: Prospective study. Setting: Polyvalent ICU of a university hospital. Patients: 359 patients. Interventions: We compared 24-h CrCl (CrCl-24h), as the standard measure, with 2-h CrCl (CrCl-2h) (at the start of the period) and the Cockroft-Gault equation (Ck-G). Measurements and results: The 2-h sample was lost in two patients (0.6%) and the 24-h sample was lost in 50 patients (13.9%). The mean Ck-G was 87.4 +/- 3.05, with CrCl-2h 109.2 +/- 4.46 and CrCl-24h 100.9 +/- 4.21 ml/min/1.73 m(2) (r(2) of 0.88 for CrCl-2h and 0.84 for Ck-G). The differences from ClCr-24h were 21.8 +/- 3.3 (p < 0.001) for the Ck-G and 8.3 +/- 2.6 (p < 0.05) for CrCl-2h ( < 0.05). In the subgroup of patients with CrCl-24h < 100 ml/min/1.73 m(2), the CrCl-24h value was 52.9 +/- 2.71 vs. 51.6 +/- 2.14 for CrCl-2h (p = ns) and 57.6 +/- 2.56 (p < 0.001) for the Ck-G. Patients with CrCl < 100 ml/min only showed variability in hyperglycemia during the 24-h period. Conclusions: In intensive care patients, 24-h CrCl results in a large proportion of non-valid determinations, even under conditions of close monitoring. Two-hour CrCl is an adequate substitute, even in patients who are unstable or who have irregular diuresis where a 24-h collection is impossible. The Cockroft-Gault equation seems less useful in this setting.