scholarly journals Augmented Renal Clearance Following Traumatic Injury in Critically Ill Patients Requiring Nutrition Therapy

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1681
Author(s):  
Roland N. Dickerson ◽  
Christin N. Crawford ◽  
Melissa K. Tsiu ◽  
Cara E. Bujanowski ◽  
Edward T. Van Matre ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutrition Therapy ◽  
Serum Creatinine Concentration ◽  
Urine Collection ◽  
Augmented Renal Clearance ◽  
Creatinine Concentration ◽  
Traumatic Injuries

The intent of this study was to ascertain the prevalence of augmented renal clearance (ARC) in patients with traumatic injuries who require nutrition therapy and identify factors associated with ARC. Adult patients admitted to the trauma intensive care unit from January 2015 to September 2016 who received enteral or parenteral nutrition therapy and had a 24 h urine collection within 4 to 14 days after injury were retrospectively evaluated. Patients with a serum creatinine concentration > 1.5 mg/dL, required dialysis, or had an incomplete urine collection were excluded. ARC was defined as a measured creatinine clearance > 149 mL/min/1.73 m2. Two hundred and three patients were evaluated. One hundred and two (50%) exhibited ARC. A greater proportion of patients with ARC were male (86% vs. 67%; p = 0.004), had traumatic brain injury (33% vs. 9%; p = 0.001), a higher injury severity score (30 ± 11 vs. 26 ± 12; p = 0.015), were younger (36 ± 15 vs. 54 ± 17 years; p = 0.001), had a lower serum creatinine concentration (0.7 ± 2 vs. 0.9 ± 0.2 mg/dL; p = 0.001) and were more catabolic (nitrogen balance of −10.8 ± 13.0 vs. −6.2 ± 9.2 g/d; p = 0.004). The multivariate analysis revealed African American race and protein intake were also associated with ARC. Half of critically ill patients with traumatic injuries experience ARC. Patients with multiple risk factors for ARC should be closely evaluated for dosing of renally-eliminated electrolytes, nutrients, and medications.

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.

Iohexol clearance in unstable critically ill patients: a tool to assess glomerular filtration rate

2016 ◽  
Vol 54 (11) ◽  
Author(s):  
Charlotte Salmon-Gandonnière ◽  
Isabelle Benz-de Bretagne ◽  
Emmanuelle Mercier ◽  
Aurélie Joret ◽  
Jean-Michel Halimi ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Filtration Rate ◽  
Circulatory Failure ◽  
Serum Creatinine Concentration ◽  
Acute Circulatory Failure ◽  
Creatinine Concentration

AbstractBackground:Acute kidney injury (AKI) is associated with significant morbidity and mortality, particularly in unstable critically ill patients. In this context, serum creatinine concentration is an imperfect tool for estimating glomerular filtration rate (GFR), an index of renal function. The objective of this pilot study was to evaluate the feasibility of measuring iohexol clearance for GFR assessment in critically ill patients with acute circulatory failure at intensive care unit (ICU) admission.Methods:ICU patients were prospectively included within 12 h of acute circulatory failure; a non-toxic dose of iohexol (5 mL) was infused intravenously and iohexol plasma concentration decrease was measured over 24 h. Urinary iohexol concentration was measured in urine samples collected four times, every 6 h for 24 h. The Kidney Disease Improving Global Outcome score, measuring AKI, was calculated each day.Results:Among 18 patients with acute circulatory failure, AKI developed in 15; 14 showed decreased serum creatinine concentration during the first 24 h even though 10 presented AKI. The absolute variation in serum creatinine concentration was correlated with fluid balance over 24 h. Median [min; max] plasma clearance of iohexol was 39.4 mL/min [6.1; 154.0] and iohexol urinary clearance 32.8 mL/min [0.8–170.4]. The correlation between plasma and urinary clearance was ρ=0.97, p<0.0001.Conclusions:GFR may be estimated by plasma iohexol clearance in unstable critically ill patients. This method is reliable, correlates very well with urinary iohexol clearance and does not depend on input/output fluid balance and fluid infusion, as compared with serum creatinine concentration.

scholarly journals Safety of a Nurse-Driven Standardized Potassium Replacement Protocol in Critically Ill Patients With Renal Insufficiency

2021 ◽  
Vol 41 (2) ◽  
pp. e10-e16
Author(s):  
Rebecca Conley ◽  
Rebecca L. Rich ◽  
Jennifer Montero
Keyword(s):  
Renal Insufficiency ◽  
Serum Creatinine ◽  
Critically Ill ◽  
Serum Potassium ◽  
Critically Ill Patients ◽  
Potassium Concentration ◽  
Serum Creatinine Concentration ◽  
Creatinine Concentration ◽  
Potassium Replacement ◽  
Electrolyte Replacement

Background In critically ill patients, maintaining appropriate serum potassium concentrations requires careful supplementation to correct hypokalemia but avoid hyperkalemia. At the study institution, an institution-based, nurse-driven standardized electrolyte replacement protocol is used in critically ill patients with a serum creatinine concentration of 2 mg/dL or less. If the serum creatinine concentration is greater than 2 mg/dL, electrolyte replacement requires a physician order. Objective To determine if standardized potassium supplementation is safe in critically ill patients with renal insufficiency not requiring renal replacement therapy. Methods This study was an institutional review board–approved, single-center, retrospective evaluation of critically ill patients receiving intravenous potassium replacement per protocol. Patients were grouped according to serum creatinine concentration (≤ 2 mg/dL or &gt; 2 mg/dL) at the time of replacement. The primary outcome was the incidence of hyperkalemia (potassium concentration ≥ 5 mEq/L) following potassium replacement. Secondary outcomes were the incidence of hyperkalemia, change in serum potassium concentration, and need for hyperkalemia treatment. Outcomes were analyzed using χ2 and t tests. Results Of 814 patients screened, 145 were included (99 with serum creatinine ≤ 2 mg/dL and 46 with serum creatinine &gt; 2 mg/dL). The incidence of hyperkalemia was not different between groups (P = .57). Five patients experienced hyperkalemia; none received hyperkalemia treatment. Change in serum potassium was similar for patients in the 2 groups (P = .33). Conclusions A standardized, nurse-driven electrolyte replacement protocol can be used safely in critically ill patients with renal insufficiency not requiring renal replacement therapy.

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

scholarly journals Augmented Renal Clearance in Iranian Critically Ill Patients: Retrospective Study at Masih Daneshvari Hospital

2017 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Seyed Reza Saghebi ◽  
Behrooz Farzanegan ◽  
Payam Tabarsi ◽  
Rokhsaneh Zangooi ◽  
Batoul Khoundabi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance

1135: Incidence and Clinical Outcomes of Critically Ill Patients With Augmented Renal Clearance

2020 ◽  
Vol 49 (1) ◽  
pp. 569-569
Author(s):  
Yeshwanter Radhakrishnan ◽  
Ali Syed ◽  
Jaimini Patel ◽  
Chanda Mullen ◽  
Michaelia Cucci
Keyword(s):  
Renal Clearance ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Augmented Renal Clearance

scholarly journals Evaluation of standard dosing for selected broad spectrum Hydrophilic antibiotics in critically ill patients with Augmented renal clearance: An observational Study

2021 ◽  
Author(s):  
Majed Almutairi ◽  
Khalid Al Sulaiman ◽  
Sultan Alenazi ◽  
Ramesh Vishwakarma ◽  
Ohoud Aljuhani
Keyword(s):  
Renal Clearance ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Broad Spectrum ◽  
Critically Ill Patients ◽  
P Value ◽  
Augmented Renal Clearance ◽  
Medical City ◽  
Calculated Creatinine Clearance ◽  
Inappropriate Antibiotics

Abstract Background: Inappropriate antibiotics dosing in critically ill patients with augmented renal clearance (ARC) may be associated with pathogens resistance and worse outcomes. Unfortunately, studies regarding the relationship between ARC and clinical outcomes in patients treated with antibiotics medication are rare. The study evaluates the efficacy and clinical outcomes of selected broad-spectrum hydrophilic antibiotics in ARC critically ill patients with confirmed infections. Methods: A retrospective cohort study in adult critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received standard dosing of selected broad-spectrum hydrophilic antibiotics (Meropenem, Imipenem, or Piperacillin/Tazobactam) with confirmed infection. All the patients who met our inclusion criteria during the study period (01/01/2018 – 31/12/2019) were included. Eligible patients have been divided into two groups (ARC Vs. non-ARC) according to the calculated creatinine clearance using the Cockcroft-Gault equation. The primary outcome was to assess pathogen eradication at 10-14 days; other outcomes were considered secondary. Multivariate logistic and generalized linear regression analyses were used. We considered a P value of < 0.05 statistically significant. Results: A total of 133 patients were included in the study; 67 Patients had ARC. The distribution of infections and types of pathogens between the groups were the same. The pathogen eradication at 10-14 days was similar between the two groups (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). Moreover, the odds of resistance development and persistence after 3 days were not significantly different between the groups ((OR 0.78; 95% CI, 0.25–2.40 p = 0.66) and (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) respectively). Conclusion: Using standard dosing of Meropenem, Imipenem, or Piperacillin/Tazobactam in ARC patients was not associated with therapy failure. Further randomized clinical and interventional studies are required to confirm our findings.

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