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Impaired kidney function relevant for toxin clearance[1]

Impaired kidney function relevant for toxin clearance[1]
Moderate to severe acute kidney injury (increase in serum creatinine 2 times baseline)*
The presence of oliguria (urine output of <0.5 mL/kg per hour) for more than 6 hours, regardless of serum creatinine concentration
Chronic kidney disease with a baseline eGFR <45 mL/minute per 1.73 m2
If baseline serum creatinine concentration is unknown:
  • Creatinine >2 mg/dL (>176 micromol/L) in an average adult
  • Creatinine >1.5 mg/dL (>132 micromol/L) in an older patient or patient with low muscle mass
In a child without a baseline creatinine concentration, a serum creatinine greater than twice the upper limit of normal for age and sex
The presence of any one of these criteria is considered impaired kidney function relevant for toxin clearance.

eGFR: estimated glomerular filtration rate.

* Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or worse.

¶ Refer to UpToDate calculator for determining the eGFR; however, the creatinine used in this calculator must be a steady-state value (ie, prior to salicylate toxicity) and not a rising creatinine obtained during the course of toxicity.
Reference:
  1. Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal treatment for salicylate poisoning: Systematic review and recommendations from the EXTRIP Workgroup. Ann Emerg Med 2015; 66:165.
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