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Concordance between glomerular filtration rate estimation equations and 4-hour urinary creatinine clearance in critically ill patients with severe trauma
Concordancia entre las ecuaciones de estimación del filtrado glomerular y el aclaramiento de creatinina en orina de 4 horas en pacientes críticos con trauma grave
L.M. Charco Rocaa,
Corresponding author
luisacharco@gmail.com

Corresponding author.
, A. Ortega Cerratob, J.J. Tortajada Solera
a Área de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
b Área de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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using certain equations that are based on the determination of serum creatinine and anthropometric variables&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The eGFR is used to determine the patient&#8217;s stage of chronic kidney disease &#40;CKD&#41;&#44; and when considered alone it is prognostic for mortality or the need for renal replacement therapy outside the ICU&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is a growing body of evidence that although the equations used to estimate GFR has been validated in chronic patients&#44; they are not suitable for critically ill patients in whom continuous fluctuations in the GFR are part of the pathophysiological dynamic of critical illness&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The gold standard for estimating the GFR consists of measuring the clearance of exogenous markers &#40;usually isotopes&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Given the complexity of performing this analysis in routine clinical practice&#44; the most widely used method consists of measuring the clearance of endogenous substances&#44; usually creatinine &#40;CrCl&#41; in urine collected over 24<span class="elsevierStyleHsp" style=""></span>h&#46; Shorter collection periods have also been validated&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The aim of this study was to estimate the accuracy of equation-based GFR estimations by comparing them with levels of CrCl in urine collected over 4<span class="elsevierStyleHsp" style=""></span>h &#40;4h-CrCl&#41; in the subpopulation of critically ill patients admitted for severe trauma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0035" class="elsevierStylePara elsevierViewall">Observational study performed in the Anaesthesiology ICU of the Hospital General Universitario de Albacete based on a retrospective analysis of the data obtained in a previous prospective study performed to determine the prevalence of GH in patients admitted for severe trauma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data from patients age 18 years of age or older&#44; with a bladder catheter&#44; with no documented history of kidney failure&#44; who did not receive renal replacement therapy over the study period&#44; who survived the first 24<span class="elsevierStyleHsp" style=""></span>h of admission&#44; with a consent form signed either by the patient or their representative were collected for analysis&#46; The study protocol was approved by our hospital&#8217;s Research Ethics Committee&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following data were collected for this study&#58; creatinine on admission&#44; anthropometric data &#40;age&#44; sex&#44; weight&#44; and height&#41;&#44; Sequential Organ Failure Assessment &#40;SOFA&#41; Score<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and Injury Severity Score &#40;ISS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Each patient&#8217;s 4h-CrCl was measured at various time points during the first week of admission&#46; Plasma creatinine levels determined in routine ICU lab tests were used&#44; and the following formula was applied<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a>&#59; 4h-CrCl&#58; &#91;Diuresis in ml &#40;urine&#47;4<span class="elsevierStyleHsp" style=""></span>h&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>urine creatinine &#40;mg&#47;dl&#41;&#93;<span class="elsevierStyleHsp" style=""></span>&#247;<span class="elsevierStyleHsp" style=""></span>&#91;240 &#40;min&#41;<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>plasma creatinine &#40;mg&#47;dl&#41;&#93;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Subsequently&#44; eGFR was calculated using the following equations &#40;as presented in the reference studies&#41;&#58; Cockroft&#8211;Gault &#40;CG&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Jelliffe&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> MDRD &#40;Modification of Diet in Renal Disease&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> t-MDRD &#40;Trauma - Modification of Diet in Renal Disease&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and CKD-EPI &#40;Chronic Kidney Disease Epidemiology Collaboration&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">All the results are expressed in terms of body surface area &#40;BSA&#41; &#40;ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To determine the level of concordance between the different measurements&#44; patients were grouped by kidney function based on an adaptation of CrCl intervals published elsewhere<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#58; high CrCl or GH was defined as CrCI<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#59; normal kidney function was defined as CrCl<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>130 and up to 70<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#59; moderate kidney injury was defined CrCl between 69 and 50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#59; and severe kidney injury was defined CrCl<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The descriptive analysis was performed using the usual measures of central tendency and dispersion &#40;mean and standard deviation&#44; or median and interquartile range&#41;&#46; In the bivariate analysis&#44; the Student t-test was used for parametric variables and the Mann&#8211;Whitney U test for non-parametric variables&#46; Fisher&#8217;s exact test and chi-square were used to compare proportions&#46; A statistical significance level of p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;05 was chosen&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Statistical analysis was performed on R Version 4&#46;0&#46;4&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">A total of 85 patients and 148 4h-CrCl measurements were included&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Median age was 51 years &#40;IQR 26&#41;&#59; 68 patients were men &#40;78&#46;82&#37;&#41;&#44; and 75&#46;29&#37; presented multiple trauma&#44; defined as 2 or more severe &#40;life-threatening&#41; traumatic injuries&#59; median number of injuries was 2&#44; and the median ISS and SOFA scores on admission were 25 and 4&#44; respectively&#46; Median stay in the ICU was 5 days&#46; The mean BSA-adjusted CrCl &#40;4h-CrCl ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; was 84&#46;5<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The eGFR calculated using the afore-mentioned equations and its correlation with 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; We only found a statistically significant correlation between 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> and eGFR calculated by the t-MDRD&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">We found that only the CG equation was correct in classifying patients in the 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> group&#46; This finding was statistically significant &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">GFR is calculated on the basis of plasma clearance of a substance that has passed through the kidneys&#46; Clearance is defined as the volume of plasma that is completely free of said substance as it passes through the kidney per unit of time &#40;ml&#47;min&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">To estimate GFR&#44; the substance used must be freely filtered&#44; neither reabsorbed or secreted by the renal tubule&#44; and must not undergo extrarenal elimination&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Under normal conditions&#44; serum creatinine is freely filtered at the glomerulus and 10&#37;&#8211;15&#37; is secreted by the renal tubule&#46; Due to this tubular secretion&#44; which can be as high as 50&#37; in patients with kidney failure&#44; GFR may be overestimated in some cases when it is calculated on the basis of serum creatinine&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The endogenous creatinine clearance formula is reserved for special cases in which serum creatinine levels are influenced by patient-dependent factors &#40;special diets&#44; loss of muscle mass&#44; pregnancy&#44; extreme body mass indexes&#44; etc&#46;&#41; and mathematical formulas based on serum creatinine instead of CrCl may underestimate the GFR&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Several equations that calculate eGFR on the basis of serum creatinine and certain anthropometric and demographic variables have been developed and validated for use in routine clinical practice&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the case of the Cock&#8211;Croft&#8211;Gault formula &#8211; developed in 1973 &#8211; the authors warned that the data used in their formula were only applicable in patients with stable GFR&#44; such as those with chronic disease&#46; The drawback of this formula&#44; therefore&#44; is that it is only validated in the population on which it is based &#40;white men with stable disease and no diabetes&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The MDRD study equation was developed in 1999 to improve the accuracy of the Cockcroft&#8211;Gault formula by measuring GFR rather than CrCl&#46; This equation estimates GFR adjusted for body surface area and also for race&#44; as black subjects are considered to have a higher mean serum creatinine level due to their greater muscle mass&#46; In the MDRD study population&#44; GFR estimations were more accurate than estimations performed using the Cock&#8211;Croft&#8211;Gault method&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Both equations &#40;particularly the MDRD&#41; underestimate the real GFR when used in healthy subjects with a GFR<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> or in patients with incipient diabetic nephropathy who present hyperfiltration&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our study supports the findings of other authors&#44; namely&#44; that the CKD-EPI equation is more accurate than the MDRD&#44; particularly in patients with GFR<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#44; where the MDRD equation underestimates GFR values and classifies many patients as CKD &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In our study&#44; we focused on a particular subpopulation of critically ill patients&#44; namely&#44; individual with no clinical history of significance who are critically ill due to severe trauma&#46; This level of injury triggers a major physiological response that affects multiple organ systems&#44; including the kidneys&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Other authors have observed that these patients are highly likely to present HF&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> and for this reason we created a group with CrCl<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>130<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> based on previous studies that have used this cut-off point&#46; In this series&#44; 20&#46;95&#37; of the 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> measurements were classified as HF&#46; All the GFR equations studied performed poorly&#44; but the CG equation provided the closest estimation &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">It is important to bear in mind that GFR is only part of the overall kidney function &#40;synthesis is excluded&#41;&#44; and that tubular reabsorption and tubular filtration are not taken into account in any of the formulas mentioned here&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">Equation-based estimations of GFR are only useful in patients with stable serum creatinine levels&#44; and should not therefore be used when levels fluctuate&#46; Serum creatinine levels are affected by patient-dependent factors that occur in specific situations&#44; and several of these may combine in critically ill patients&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In these cases&#44; estimating GFR using mathematical formulas instead of calculating CrCl may even underestimate the true GFR&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">We recommend including real-time monitoring of kidney function and calculation of CrCl as part of the study of kidney function in critically ill patients&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0175" class="elsevierStylePara elsevierViewall">This study has not received specific funding from agencies in the private&#44; public and nonprofit sectors&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0180" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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          "titulo" => "Resumen"
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              "titulo" => "Antecedentes y objetivo"
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    "fechaRecibido" => "2022-08-22"
    "fechaAceptado" => "2023-01-11"
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          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Glomerular filtration rate"
            1 => "Creatinine clearance"
            2 => "Critically ill patient"
            3 => "Polytraumatized patient"
            4 => "Glomerular filtration"
          ]
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        0 => array:4 [
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          "palabras" => array:5 [
            0 => "Filtrado glomerular"
            1 => "Aclaramiento de creatinina"
            2 => "Paciente cr&#237;tico"
            3 => "Politraumatizado"
            4 => "Ecuaciones de estimaci&#243;n de filtrado glomerular"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">There is a growing body of evidence that the equations used to estimate the glomerular filtration rate &#40;GFR&#41; are not suitable in critically ill patients&#44; a population whose GFR fluctuates continuously&#46; Glomerular filtration is usually estimated by measuring urine creatinine clearance &#40;CrCl&#41; at various time points&#46; The aim of our study was to evaluate the performance of the most widely used GFR calculators in the subpopulation of critically ill patients admitted for severe trauma&#44; and to compare the results against determinations of CrCl in urine collected over a 4-h period &#40;4h-CrCl&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Observational study in patients hospitalized for severe trauma&#46; We measured the 4h-CrCl and estimated GFR using the Cockcroft&#8211;Gault&#44; modified Jelliffe&#44; MDRD&#44; t-MDRD&#44; and CKD-EPI equations&#44; adjusting the results for body surface area &#40;BSA&#41; &#40;ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46; Data were analysed using R version 4&#46;0&#46;4&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A total of 85 patients were included&#46; Median age was 51 years&#44; and 68 were men &#40;78&#46;82&#37;&#41;&#46; The mean BSA-adjusted 4h-CrCl &#40;4h-ClCr&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; was 84&#46;5 ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; We found that GFR estimated using the t-MDRD equation correlated significantly with 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; The Cockcroft&#8211;Gault equation correlated significantly with 4h-CrCl&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> when GFR was greater than 130<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">In ICU patients&#44; glomerular filtration can be reliably estimated by determining urine CrCl&#44; but GFR calculators are not accurate in this population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Cada vez hay m&#225;s estudios que evidencian que las ecuaciones utilizadas para conocer la tasa de filtrado glomerular estimada &#40;TFGe&#41; no son adecuadas para los pacientes cr&#237;ticos en los que se producen continuas variaciones del filtrado glomerular &#40;FG&#41;&#46; El m&#233;todo m&#225;s pr&#225;ctico para aproximarse al estudio del FG es el c&#225;lculo del aclaramiento de creatinina &#40;ClCr&#41; en periodos de recogida de orina variables&#46; El objetivo del estudio fue observar el comportamiento de las ecuaciones empleadas para estimar el filtrado glomerular cuando se aplican a la subpoblaci&#243;n de pacientes cr&#237;ticos ingresados por trauma grave y comparar el ClCr en orina recogida en un periodo de 4 horas &#40;ClCr-4h&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional que incluye pacientes ingresados por trauma grave&#46; Se calcul&#243; el ClCr-4h y se determin&#243; la TFGe mediante las ecuaciones de Cockcroft-Gault&#44; Jelliffe modificada&#44; MDRD&#44; t-MDRD y CKD-EPI&#46; Los resultados se expresan referidos a superficie corporal &#40;ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41;&#46; Los an&#225;lisis se realizaron con el software estad&#237;stico R versi&#243;n 4&#46;0&#46;4&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 85 pacientes&#46; La edad mediana de los pacientes fue de 51 a&#241;os&#59; 68 pacientes fueron varones &#40;78&#44;82&#37;&#41;&#46; El ClCr-4h ajustado a superficie corporal &#40;ClCr-4h ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; medio fue de 84&#44;5<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; Hallamos correlaci&#243;n estad&#237;sticamente significativa de ClCr-4h&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> con la TFGe por t-MDRD&#46; Para ClCr-4h&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span> mayores de 130<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span> la ecuaci&#243;n de Cockcroft-Gault identifica a los pacientes correctamente de una forma estad&#237;sticamente significativa&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">El c&#225;lculo de ClCr en el entorno de UCI proporciona datos fiables del FG&#44; no siendo adecuado el uso de ecuaciones estimativas&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation between 4-h urine creatinine clearance adjusted for body surface area &#40;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; and glomerular filtration rate estimated by study equations&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CKD-EPI&#59; Chronic Kidney Disease Epidemiology Collaboration&#44; MDRD&#59; Modification of Diet in Renal Disease&#44; t-MDRD&#59; Trauma - Modification of Diet in Renal Disease&#46;</p>"
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      1 => array:8 [
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients classified by study equations and 4-h urine creatinine clearance adjusted for body surface area &#40;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#41; according to kidney function&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">4-hCrCl ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#58; urine creatinine clearance over 4<span class="elsevierStyleHsp" style=""></span>h adjusted for body surface area&#59; CKD-EPI&#59; Chronic Kidney Disease Epidemiology Collaboration&#59; GH&#59; glomerular hyperfiltration&#44; MDRD&#59; Modification of Diet in Renal Disease&#44; t-MDRD&#59; Trauma - Modification of Diet in Renal Disease&#46;</p>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">4h-CrCl&#59; urine creatinine clearance over 4<span class="elsevierStyleHsp" style=""></span>h&#44; 4h-CrCl ml&#47;min&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#59; 4h-CrCl adjusted for body surface area&#59; BSA&#59; body surface area&#44; Cr&#59; plasma creatinine&#59; IQR&#59; interquartile range&#44; SD&#59; standard deviation&#46;</p>"
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                  \t\t\t\t" scope="col">Study group&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&#44; years&#44; median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">51 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Men n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;78&#46;82&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Women n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#46;18&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">BSA in m<span class="elsevierStyleSup">2</span>&#44; mean &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;87 &#40;0&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median ISS &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median SOFA &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median length of stay &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cr at admission mg&#47;dl median &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;87 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4h-CrCl ml&#47;min mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">145&#46;9 &#40;73&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4h-CrCl ml&#47;min&#47;1&#46;73<span class="elsevierStyleSup">2</span> mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#46;5 &#40;42&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Multiple trauma n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">64 &#40;75&#46;29&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Median number of injuries &#40;IQR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">84&#46;5 &#40;42&#46;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Jelliffe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">87&#46;1 &#40;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">MDRD&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">107&#46;4 &#40;52&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">126&#46;5 &#40;17&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">106&#46;7 &#40;40&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;28&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">CKD-EPI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">66&#46;66&#37; &#40;p 0&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Moderate dysfunction&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#8804;130&#8211;70<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">69&#8211;50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#60;50<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4h-ClCr&#47;1&#46;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#46;95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Jelliffe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">t-MDRD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">56&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CKD-EPI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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