Faculty Opinions recommendation of Four hour creatinine clearance is better than plasma creatinine for monitoring renal function in critically ill patients.

Abstract Introduction: Elevated intraabdominal pressure (IAP) it is known to have an impact on renal function trough the pressure transmitted from the abdominal cavity to the vasculature responsible for the renal blood flow. Intraabdominal pressure is found to be frequent in intensive care patients and also to be a predictor of mortality. Intra-abdominal high pressure is an entity that can have serious impact on intensive care admitted patients, studies concluding that if this condition progresses to abdominal compartment syndrome mortality is as high as 80%. Aim: The aim of this study was to observe if a link between increased intraabdominal pressure and modification in renal function exists (NGAL, creatinine clearance). Material and Method: The study enrolled 30 critically ill patients admitted in the Intensive Care Unit of SCJU Tîrgu Mures between November 2015 and August 2016. The study enrolled adult, hemodynamically stable patients admitted in intensive critical care - defined by a normal blood pressure maintained without any vasopressor or inotropic support, invasive monitoring using PICCO device and abdominal pressure monitoring. Results: The patients were divided into two groups based on the intraabdominal pressure values: normal intraabdominal pressure group= 52 values and increased intraabdominal group= 35 values. We compared the groups in the light of NGAL values, 24 hours diuresis, GFR and creatinine clearance. The groups are significantly different when compared in the light of NGAL values and GFR values. We obtained a statistically significant correlation between NGAL value and 24 hour diuresis. No other significant correlations were encountered between the studied items. Conclusions: NGAL values are increased in patients with high intraabdominal pressure which may suggest its utility as a cut off marker for patients with increased intraabdominal pressure. There is a significant decreased GFR in patient with elevated intraabdominal pressure, observation which can help in early detection of renal injury in patients due to high intraabdominal pressure. No correlation was found between creatinine clearance and increased intraabdominal pressure.

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Area under the Curve-Based Dosing of Vancomycin in Critically Ill Patients Using 6-Hour Urine Creatinine Clearance Measurement

Critical Care Research and Practice ◽

10.1155/2020/8831138 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Bita Shahrami ◽

Farhad Najmeddin ◽

Saeideh Ghaffari ◽

Atabak Najafi ◽

Mohammad Reza Rouini ◽

...

Keyword(s):

Renal Function ◽

Creatinine Clearance ◽

Critically Ill ◽

Normal Renal Function ◽

Critically Ill Patients ◽

Area Under The Curve ◽

Total Daily Dose ◽

Pharmacokinetic Parameters ◽

Concentration Data ◽

Urine Creatinine

Background. The area under the curve- (AUC-) guided vancomycin dosing is the best strategy for individualized therapy in critical illnesses. Since AUC can be calculated directly using drug clearance (CLvan), any parameter estimating CLvan will be able to achieve the goal of 24-hour AUC (AUC24 h). The present study was aimed to determine CLvan based on 6-hour urine creatinine clearance measurement in critically ill patients with normal renal function. Method. 23 adult critically ill patients with an estimated glomerular filtration rate (eGFR) ≥60 mL/min who received vancomycin infusion were enrolled in this pilot study. Vancomycin pharmacokinetic parameters were determined for each patient using serum concentration data and a one-compartment model provided by MONOLIX software using stochastic approximation expectation-maximization (SAEM) algorithm. Correlation of CLvan with the measured creatinine clearance in 6-hour urine collection (CL6 h) and estimated creatinine clearance by the Cockcroft–Gault formula (CLCG) was investigated. Results. Data analysis revealed that CL6 h had a stronger correlation with CLvan rather than CLCG (r = 0.823 vs. 0.594; p < 0.001 vs. 0.003). The relationship between CLvan and CL6 h was utilized to develop the following equation for estimating CLvan: CLvan (mL/min) = ─137.4 + CL6 h (mL/min) + 2.5 IBW (kg) (R2 = 0.826, p < 0.001 ). Regarding the described model, the following equation can be used to calculate the empirical dose of vancomycin for achieving the therapeutic goals in critically ill patients without renal impairment: total daily dose of vancomycin (mg) = (─137.4CL6-h (mL/min) + 2.5 IBW (kg)) × 0.06 AUC24 h (mg.hr/L). Conclusion. For AUC estimation, CLvan can be obtained by collecting urine in a 6-hour period with good approximation in critically ill patients with normal renal function.

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Does Critical Illness Change Levofloxacin Pharmacokinetics?

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02610-15 ◽

2015 ◽

Vol 60 (3) ◽

pp. 1459-1463 ◽

Cited By ~ 10

Author(s):

Jason A. Roberts ◽

Menino Osbert Cotta ◽

Piergiorgio Cojutti ◽

Manuela Lugano ◽

Giorgio Della Rocca ◽

...

Keyword(s):

Renal Function ◽

Critical Illness ◽

Creatinine Clearance ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Indication ◽

Independent Effect ◽

Pharmacokinetic Analysis ◽

Population Pharmacokinetic ◽

The Mean

Levofloxacin is commonly used in critically ill patients for which existing data suggest nonstandard dosing regimens should be used. The objective of this study was to compare the population pharmacokinetics of levofloxacin in critically ill and in non-critically ill patients. Adult patients with a clinical indication for levofloxacin were eligible for participation in this prospective pharmacokinetic study. Patients were given 500 mg or 750 mg daily by intravenous administration with up to 11 blood samples taken on day 1 or 2 of therapy. Plasma samples were analyzed and population pharmacokinetic analysis was undertaken using Pmetrics. Thirty-five patients (18 critically ill) were included. The mean (standard deviation [SD]) age, weight, and Cockcroft-Gault creatinine clearance for the critically ill and for the non-critically ill patients were 60.3 (16.4) and 72.0 (11.6) years, 78.5 (14.8) and 70.9 (15.8) kg, and 71.9 (65.8) and 68.2 (30.1) ml/min, respectively. A two-compartment linear model best described the data. Increasing creatinine clearance was the only covariate associated with increasing drug clearance. The presence of critical illness did not significantly affect any pharmacokinetic parameter. The mean (SD) parameter estimates were as follows: clearance, 8.66 (3.85) liters/h; volume of the central compartment (Vc), 41.5 (24.5) liters; intercompartmental clearance constants from central to peripheral, 2.58 (3.51) liters/h; and peripheral to central compartments, 0.90 (0.58) liters/h. Monte Carlo dosing simulations demonstrated that achievement of therapeutic exposures was dependent on renal function, pathogen, and MIC. Critical illness appears to have no independent effect on levofloxacin pharmacokinetics that cannot be explained by altered renal function.

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A comparison of CKD-EPI estimated glomerular filtration rate and measured creatinine clearance in recently admitted critically ill patients with normal plasma creatinine concentrations

BMC Nephrology ◽

10.1186/1471-2369-14-250 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 29

Author(s):

Andrew A Udy ◽

Fraser JA Morton ◽

Sallyanne Nguyen-Pham ◽

Paul Jarrett ◽

Melissa Lassig-Smith ◽

...

Keyword(s):

Glomerular Filtration Rate ◽

Creatinine Clearance ◽

Glomerular Filtration ◽

Critically Ill ◽

Critically Ill Patients ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Plasma Creatinine ◽

Normal Plasma

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

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v17i1.823 ◽

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.

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