1551: THE IMPACT OF AUGMENTED RENAL CLEARANCE ON VANCOMYCIN THERAPY IN CRITICALLY ILL TRAUMA PATIENTS

The main objective of this pilot study was to determine the association between augmented renal clearance (ARC), urinary nitrogen loss and muscle wasting in critically ill trauma patients. We conducted a retrospective analysis of a local database in 162 critically ill trauma patients without chronic renal dysfunction. Nutritional-related parameters and 24 h urinary biochemical analyses were prospectively collected and averaged over the first ten days after admission. Augmented renal clearance was defined by a mean creatinine clearance (CLCR) > 130 mL/min/1.73 m2. The main outcome was the cumulated nitrogen balance at day 10. The secondary outcome was the variation of muscle psoas cross-sectional area (ΔCSA) calculated in the subgroup of patients who underwent at least two abdominal CT scans during the ICU length of stay. Overall, there was a significant correlation between mean CLCR and mean urinary nitrogen loss (normalized coefficient: 0.47 ± 0.07, p < 0.0001). ARC was associated with a significantly higher urinary nitrogen loss (17 ± 5 vs. 14 ± 4 g/day, p < 0.0001) and a lower nitrogen balance (−6 ± 5 vs. −4 ± 5 g/day, p = 0.0002), without difference regarding the mean protein intake (0.7 ± 0.2 vs. 0.7 ± 0.3 g/kg/day, p = 0.260). In the subgroup of patients who underwent a second abdominal CT scan (N = 47), both ΔCSA and %ΔCSA were higher in ARC patients (−33 [−41; −25] vs. −15 [−29; −5] mm2/day, p = 0.010 and −3 [−3; −2] vs. −1 [−3; −1] %/day, p = 0.008). Critically ill trauma patients with ARC are thus characterized by a lower nitrogen balance and increased muscle loss over the 10 first days after ICU admission. The interest of an increased protein intake (>1.5 g/kg/day) in such patients remains a matter of controversy and must be confirmed by further randomized trials.

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Pharmacists’ Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study

Infectious Diseases and Therapy ◽

10.1007/s40121-020-00310-9 ◽

2020 ◽

Vol 9 (3) ◽

pp. 599-608

Author(s):

Abdulaziz S. Almulhim ◽

Batool A. Al-Dahneen ◽

Yazed S. Alsowaida

Keyword(s):

Renal Clearance ◽

Critically Ill ◽

Critically Ill Patients ◽

Cross Sectional Study ◽

Sectional Study ◽

Augmented Renal Clearance ◽

Cross Sectional ◽

The Impact

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Augmented renal clearance in critically ill trauma patients: A pathophysiologic approach using renal vascular index

Anaesthesia Critical Care & Pain Medicine ◽

10.1016/j.accpm.2018.12.004 ◽

2019 ◽

Vol 38 (4) ◽

pp. 371-375 ◽

Cited By ~ 4

Author(s):

Cedric Carrie ◽

Alexandre Lannou ◽

Sebastien Rubin ◽

Hugues De Courson ◽

Laurent Petit ◽

...

Keyword(s):

Renal Clearance ◽

Critically Ill ◽

Trauma Patients ◽

Augmented Renal Clearance ◽

Renal Vascular

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O16 Piglets as animal model to assess the contribution of fluid therapy to the development of augmented renal clearance in children

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-esdppp.16 ◽

2019 ◽

Vol 104 (6) ◽

pp. e7.2-e7

Author(s):

L Dhondt ◽

S Croubels ◽

P De Paepe ◽

P De Cock ◽

M Devreese

Keyword(s):

Animal Model ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Renal Clearance ◽

Critically Ill ◽

Fluid Therapy ◽

Filtration Rate ◽

Fluid Administration ◽

Augmented Renal Clearance ◽

The Impact

BackgroundThe past years augmented renal clearance (ARC), observed in the critically ill paediatric population, has received an increased attention by researchers due to its major impact on drug exposure.1 Since a recent report demonstrated that the maturation of the glomerular filtration rate (GFR) in juvenile pigs is comparable to children, pigs may be a potential animal model to investigate the impact and mechanisms of ARC on drug pharmacokinetics (PK) in children.2In this pilot study, the contribution of intravenous (IV) fluid administration on the development of ARC was investigated in piglets.MethodsEight seven-week-old pigs underwent an experiment without fluid therapy and two consecutive fluid treatments as CRI of a 0.9% NaCl solution (3 mL/kg/h and 6 mL/kg/h) over 36 hours, each time combined with IV administration of a cocktail of renal markers after 4 and 24 h of fluid administration. This cocktail consisted of iohexol (64.7 mg/kg body weight (BW), Omnipaque 300®, marker for GFR) and para-aminohippuric acid (10 mg/kg BW, marker for effective renal plasma flow). To assess the impact of ARC on the PK of antimicrobials, amikacin (7,5 mg/kg BW, Amukin®) was administered after 24 h of fluid therapy. PK modelling was performed with Phoenix® WinNonlin®.ResultsGenerally, an increase in GFR was observed after fluid administration when compared to the GFR values observed without fluid administration. 4 and 2 out of 7 pigs demonstrated ARC after 4 h of a CRI at 3 mL/kg/h and 6 mL/kg/h, respectively. 4 out of 7 pigs displayed ARC after 24 h of a CRI at 3 mL/kg/h and 6 mL/kg/h. Similar results were obtained for amikacin clearance.ConclusionAn important effect of fluid therapy on the development of ARC was observed in juvenile pigs. Further research is necessary to confirm this results in critically ill children.ReferencesDhont E, et al. Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients? Pediatric Nephrology 2018.Gasthuys E, et al. Postnatal Maturation of the Glomerular Filtration Rate in Conventional Growing Piglets As Potential Juvenile Animal Model for Preclinical Pharmaceutical Research. Frontiers in Pharmacology 2017;8.Disclosure(s)This study was funded by the Special Research Fund of Ghent University (BOF16/DOC/285).

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