scholarly journals Augmented Renal Clearance in Critically Ill Patients with Sepsis: Prevalence, Risk Factors and Outcome

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Shahir Asraf bin Abdul Rahim ◽  
Azrina Md Ralib ◽  
Abdul Hadi Mohamad ◽  
Ariff Osman ◽  
Mohd Basri Mat Nor
Keyword(s):  
Risk Factors ◽  
Cardiac Index ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Estimated Glomerular Filtration Rate ◽  
Inclusion Criteria ◽  
Augmented Renal Clearance

Introduction: Augmented renal clearance (ARC) is a phenomenon where there is elevated renal clearance and defined by creatinine clearance more than 130ml/min. ARC results in changes of the pharmacokinetic and pharmacodynamic of antimicrobial therapy being administered, which may result in its subtherapeutic dose. We evaluated the prevalence, risk factors and outcome of ARC in critically ill patients with sepsis. Materials and method: This is an interim analysis of single centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis with plasma creatinine less than 130 µmol/l. Urinary creatinine and flow rate were measured and creatinine clearance (CrCl) calculated.ARC is defined as CrCl of more 130 ml/min. Ultrasonic cardiac output montoring (USCOM) was used to measure cardiac index. Results: Nineteen patients were analysed so far, of which 11 (57.9%) had ARC. There were no differences age, gender, or category of patients between patients with and without ARC. Baseline APACHE II and SOFA score were similar in the two groups (p=0.47 and 0.06, respectively).There was no difference in the hospital mortality (p=0.86). However, duration of ICU admission amongst survivors was longer in patients with ARC (10 (5-12) vs 4 (3-5) days, p=0.04). Of the 11 with ARC, 7 persisted to day 2. Measured creatinine clearance correlated well with the estimated glomerular filtration rate (r=0.68, p<0.0001), however it did not correlate with cardiac index (r=0.40, p=0.14). Conclusion: ARC occurs in almost half of critically ill patients with sepsis, and is associated with longer duration of ICU stay. However, there was no difference in the outcome in this small study. Future larger study may be important to investigate this.

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients

2018 ◽  
Vol 35 (10) ◽  
pp. 1044-1052 ◽  
Author(s):  
João Pedro Baptista ◽  
Paulo Jorge Martins ◽  
Margarida Marques ◽  
Jorge Manuel Pimentel
Keyword(s):  
Risk Factors ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Augmented Renal Clearance ◽  
Saps Ii ◽  
Male Sex

Background: Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. The aims of this study were evaluation of (1) risk factors for ARC and (2) the prevalence of ARC in critically ill patients over a period of 1 year. Methods: A retrospective cohort study was performed for all consecutive patients admitted to our intensive care unit (ICU). Augmented renal clearance was defined by a creatinine clearance ≥130 mL/min/1.73 m2. “Patient with ARC” was defined as a patient with a median of creatinine clearance ≥130 mL/min/1.73 m2 over the period of admission. Four variables were tested, Simplified Acute Physiology Score II (SAPS II), male gender, age, and trauma as cause for ICU admission. An analysis (patient based and clearance based) was performed with logistic regression. Results: Of 475 patients, 446 were included in this study, contributing to 454 ICU admissions and 5586 8-hour creatinine clearance (8h-CLCR). Overall, the prevalence of patients with ARC was 24.9% (n = 113). In a subset of patients with normal serum creatinine levels, the prevalence was 43.0% (n = 104). Of the set of all 8h-CLCR measurements, 25.4% (1418) showed ARC. In the patient-based analysis, the adjusted odds ratio was: 2.0 (confidence interval [CI]:1.1-3.7; P < .05), 0.93 (CI: 0.91-0.94; P < .01), 2.7 (CI: 1.4-5.3; P < .01), and 0.98 (CI: 0.96 -1.01; P = .15), respectively, for trauma, age, male sex, and SAPS II. In the clearance-based analysis, the adjusted odds ratio were 1.7 (CI: 1.4-1.9; P < .01), 0.94 (CI: 0.932-0.942; P < .01), and 2.9 (CI: 2.4-3.4; P < .01), respectively, for trauma, age, and male sex. Conclusions: Trauma, young age, and male sex were independent risk factors for ARC. This condition occurs in a considerable proportion of critical care patients, which was particularly prevalent in patients without evidence of renal dysfunction.

scholarly journals Augmented Renal Clearance in Critically Ill Patients in Malaysian Intensive Care Unit: Assessment of Prevalence, Risk Factors and Outcomes

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Shahir Asraf b Abdul Rahim ◽  
Azrina Md Ralib
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Plasma Creatinine ◽  
Augmented Renal Clearance ◽  
Younger Age

Introduction: Augmented renal clearance (ARC) is a phenomenon where there is elevated renal clearance and defined by creatinine clearance >130ml/min. ARC results in changes of the pharmacokinetic and pharmacodynamic of antimicrobial therapy being administered resulting in its subtherapeutic dose. We evaluated the prevalence, risk factors and outcome of ARC in critically ill patients in two Intensive Care Units (ICU) in Kuantan. Materials and Methods: This was a two centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 15 years old with plasma creatinine <130µmol/l, with arterial line and urinary catheter inserted. The creatinine clearance (CrCl) were measured using plasma creatinine, urinary creatinine and urinary flow rate. ARC is defined as CrCl of more 130ml/min. Results: Among 102 patients recruited, 57 (55.9%) had ARC. Those with younger age (39.9±19 years old, p=0.013) and lower SOFA score (2.8±2.6, p=0.012) had increased risk of developing ARC. No significant difference in other risk factors such as male and trauma were found. There was no difference in the ICU and hospital mortality (p=0.652 and p=0.128). There was also no difference in the duration of ICU admission amongst survivors with or without ARC (100.6±142.3). Measured CrCl correlated well with the estimated glomerular filtration rate (eGFR) using all four different eGFR equations (r=0.436 to 0.552, p<0.0001). Conclusion: ARC occurs in almost half of critically ill patients and more common in younger age and lower SOFA score. However, there was no difference in the outcome. eGFR may be used as surrogate in detecting ARC.

scholarly journals Select Critically ill Patients at Risk of Augmented Renal Clearance: Experience in a Malaysian Intensive Care Unit

2014 ◽  
Vol 42 (6) ◽  
pp. 715-722 ◽  
Author(s):  
S. Adnan ◽  
S. Ratnam ◽  
S. Kumar ◽  
D. Paterson ◽  
J. Lipman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
At Risk ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance ◽  
Drug Concentrations

Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of >24 hours plus an admission serum creatinine concentration <120 μmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency ( P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl ( P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with ‘normal’ serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.

scholarly journals Diabetes and Hemoglobin A1c as Risk Factors for Nosocomial Infections in Critically Ill Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Eirini Tsakiridou ◽  
Demosthenes Makris ◽  
Vasiliki Chatzipantazi ◽  
Odysseas Vlachos ◽  
Grigorios Xidopoulos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Hemoglobin A1c ◽  
District Hospital ◽  
Bloodstream Infections ◽  
Inclusion Criteria ◽  
Icu Mortality ◽  
Independent Risk Factors

Objective. To evaluate whether diabetes mellitus (DM) and hemoglobin A1c (HbA1c) are risk factors for ventilator-associated pneumonia (VAP) and bloodstream infections (BSI) in critically ill patients.Methods. Prospective observational study; patients were recruited from the intensive care unit (ICU) of a general district hospital between 2010 and 2012. Inclusion criteria: ICU hospitalization >72 hours and mechanical ventilation >48 hours. HbA1c was calculated for all participants. DM, HbA1c, and other clinical and laboratory parameters were assessed as risk factors for VAP or BSI in ICU.Results. The overall ICU incidence of VAP and BSI was 26% and 30%, respectively. Enteral feeding OR (95%CI) 6.20 (1.91–20.17;P=0.002) and blood transfusion 3.33 (1.23–9.02;P=0.018) were independent risk factors for VAP. BSI in ICU (P=0.044) and ICU mortality (P=0.038) were significantly increased in diabetics. Independent risk factors for BSI in ICU included BSI on admission 2.45 (1.14–5.29;P=0.022) and stroke on admission2.77 (1.12–6.88;P=0.029). Sepsis 3.34 (1.47–7.58;P=0.004) and parenteral feeding 6.29 (1.59–24.83;P=0.009) were independently associated with ICU mortality. HbA1c ≥ 8.1% presented a significant diagnostic performance in diagnosing repeated BSI in ICU.Conclusion. DM and HbA1c were not associated with increased VAP or BSI frequency. HbA1c was associated with repeated BSI episodes in the ICU.

scholarly journals Augmented renal clearance: a retrospective, cohort study of urinary creatinine clearance in critically ill patients in the United Kingdom

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110155
Author(s):  
Brian W Johnston ◽  
David Perry ◽  
Martyn Habgood ◽  
Miland Joshi ◽  
Anton Krige
Keyword(s):  
Risk Factors ◽  
United Kingdom ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Repeated Measures ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Augmented Renal Clearance ◽  
Urinary Creatinine ◽  
The United Kingdom

Objective Augmented renal clearance (ARC) is associated with sub-therapeutic antibiotic, anti-epileptic, and anticoagulant serum concentrations leading to adverse patient outcomes. We aimed to describe the prevalence and associated risk factors for ARC development in a large, single-centre cohort in the United Kingdom. Methods We conducted a retrospective observational study of critically unwell patients admitted to intensive care between 2014 and 2016. Urinary creatinine clearance was used to determine the ARC prevalence during the first 7 days of admission. Repeated measures logistic regression was used to determine risk factors for ARC development. Results The ARC prevalence was 47.0% (95% confidence interval [95%CI]: 44.3%–49.7%). Age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and sepsis diagnosis were significantly associated with ARC. ARC was more prevalent in younger vs. older (odds ratio [OR] 0.95 [95%CI: 0.94–0.96]), male vs. female (OR 0.32 [95%CI: 0.26–0.40]) patients with lower vs. higher APACHE II scores (OR 0.94 [95%CI: 0.92–0.96]). Conclusions This patient group probably remains unknown to many clinicians because measuring urinary creatinine clearance is not usually indicated in this group. Clinicians should be aware of the ARC risk in this group and consider measurement of urinary creatinine clearance.

Augmented Renal Clearance in Critically Ill Patients: A Systematic Review

2018 ◽  
Vol 57 (9) ◽  
pp. 1107-1121 ◽  
Author(s):  
Idoia Bilbao-Meseguer ◽  
Alicia Rodríguez-Gascón ◽  
Helena Barrasa ◽  
Arantxazu Isla ◽  
María Ángeles Solinís
Keyword(s):  
Systematic Review ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance
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