Trial reportCritical care (London, England)2013
Combining creatinine and volume kinetics identifies missed cases of acute kidney injury following cardiac arrest.
Trial report in Critical care (London, England), 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 78 citations in OpenAlex.
- Amino acid infusion and acute kidney injury after aortic surgery: a multicenter observational study with target trial emulation.Renal failure · 2026Observational
- Periprocedural Oral Hydration Patterns and Early Renal Function after Coronary Angiography and Intervention: A Prospective Real-World Cohort Study.Cardiorenal medicine · 2026Article
- Giving urine biochemistry a second chance in acute kidney injury monitoring.World journal of critical care medicine · 2025Review
- A Joint Pharmacometric Model of Iohexol and Creatinine Administered through a Meat Meal to Assess GFR and Renal OCT2/MATE Activity.Clinical pharmacology and therapeutics · 2025Article
- Predictive model for daily risk alerts in sepsis patients in the ICU: visualization and clinical analysis of risk indicators.Precision clinical medicine · 2025Article
- Decision-making in Perioperative Oliguria: Reply.Anesthesiology · 2024Article
- Glomerular filtration rate in critically ill neonates and children: creatinine-based estimations versus iohexol-based measurements.Pediatric nephrology (Berlin, Germany) · 2023Article
- A population pharmacokinetic model for creatinine with and without ingestion of a cooked meat meal.European journal of clinical pharmacology · 2022Article
- Kidney Disease Complexity Manifested: One Biomarker Size Does Not Fit All.Kidney international reports · 2022Article
- [Creatinine] can change in an unexpected direction due to the volume change rate that interacts with kinetic GFR: Potentially positive paradox.Physiological reports · 2022Article
- Survival and recovery modeling of acute kidney injury in critically ill adults.SAGE open medicine · 2022Article
- Fluid balance-adjusted creatinine in diagnosing acute kidney injury in the critically ill.Acta anaesthesiologica Scandinavica · 2021Article
- In creatinine kinetics, the glomerular filtration rate always moves the serum creatinine in the opposite direction.Physiological reports · 2021Article
- An Evaluation of Commonly Used Surrogate Baseline Creatinine Values to Classify AKI During Acute Infection.Kidney international reports · 2021Article
- Septic acute kidney injury: a review of basic research.Clinical and experimental nephrology · 2020Review
- Perioperative Renoprotection: General Mechanisms and Treatment Approaches.Anesthesia and analgesia · 2020Review
- Need for Accurate Assessment of Volume Status and Fluid Responsiveness in Critically Ill Trauma Patients: Reply to Xue and Colleagues.Journal of the American College of Surgeons · 2020Article
- The role of invasive monitoring in the resuscitation of major burns: a systematic review and meta-analysis.International journal of burns and trauma · 2019Article
- 10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns.Journal of clinical medicine · 2018Article
- Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review.International journal of molecular sciences · 2017Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionFluid resuscitation in the critically ill often results in a positive fluid balance, potentially diluting the serum creatinine concentration and delaying diagnosis of acute kidney injury (AKI).
methodsDilution during AKI was quantified by combining creatinine and volume kinetics to account for fluid type, and rates of fluid infusion and urine output. The model was refined using simulated patients receiving crystalloids or colloids under four glomerular filtration rate (GFR) change scenarios and then applied to a cohort of critically ill patients following cardiac arrest.
resultsThe creatinine concentration decreased during six hours of fluid infusion at 1 litre-per-hour in simulated patients, irrespective of fluid type or extent of change in GFR (from 0% to 67% reduction). This delayed diagnosis of AKI by 2 to 9 hours. Crystalloids reduced creatinine concentration by 11 to 19% whereas colloids reduced concentration by 36 to 43%. The greatest reduction was at the end of the infusion period. Fluid dilution alone could not explain the rapid reduction of plasma creatinine concentration observed in 39 of 49 patients after cardiac arrest. Additional loss of creatinine production could account for those changes. AKI was suggested in six patients demonstrating little change in creatinine, since a 52 ± 13% reduction in GFR was required after accounting for fluid dilution and reduced creatinine production. Increased injury biomarkers within a few hours of cardiac arrest, including urinary cystatin C and plasma and urinary Neutrophil-Gelatinase-Associated-Lipocalin (biomarker-positive, creatinine-negative patients) also indicated AKI in these patients.
conclusionsCreatinine and volume kinetics combined to quantify GFR loss, even in the absence of an increase in creatinine. The model improved disease severity estimation, and demonstrated that diagnostic delays due to dilution are minimally affected by fluid type. Creatinine sampling should be delayed at least one hour following a large fluid bolus to avoid dilution. Unchanged plasma creatinine post cardiac arrest signifies renal injury and loss of function.
trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12610001012066.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.