In Reply Dr Seres comments on the effect of low muscle mass on serum creatinine level. We agree that muscle mass and cachexia can decrease sensitivity of serum creatinine to detect a drop in GFR and AKI. Recently, Yoo and colleagues1 reported overestimation of GFR in patients with cirrhosis and with low muscle mass detected by abdominal computed tomography.2 This point was addressed in our article1 when considering the overestimation of GFR using serum creatinine at discharge from the intensive care unit due to muscle mass loss during the stay. Estimation of GFR based on creatinine clearance may be more accurate in this setting. Short-term (2-4 hours) urine collection may overcome some of the limits of creatinine clearance measurements to detect acute changes in GFR.3
Legrand M, Kellum JA. Acute Kidney Injury Related to Sepsis—Reply. JAMA. 2019;321(18):1828–1829. doi:10.1001/jama.2019.2072
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