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

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.

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

Critical Care Medicine ◽

10.1097/01.ccm.0000730428.97480.ac ◽

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

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

10.21203/rs.3.rs-726484/v3 ◽

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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Evaluation of Standard Dosing for Selected Broad Spectrum Hydrophilic Antibiotics in Critically Ill Patients with Augmented Renal Clearance: An Observational Study

10.21203/rs.3.rs-726484/v1 ◽

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 ◽

Augmented Renal Clearance ◽

Icu Length Of Stay ◽

Medical City ◽

Inappropriate Antibiotics ◽

The Relationship

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 aims to evaluate the efficacy and clinical outcomes of selected broad spectrum hydrophilic antibiotics (Meropenem, Imipinem, Piperacillin/Tazobactam) in augmented renal function critically ill patients with confirmed infections.Methods: A retrospective cohort study in critically ill patients who were admitted to intensive care units (ICUs) at King Abdulaziz Medical City (KAMC)-Riyadh and received 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 (augmented renal clearance (ARC) Vs. Non-ARC) according to the estimated creatinine clearance (CrCl) to assess pathogen eradication at 10-14 days. Results: A total of 2682 patients were screened; 133 patients were included in the study. The eradication of pathogen at 10-14 days in ARC group was non-inferior to non-ARC group (OR 1.08; 95% CI, 0.41–2.78 p = 0.88). The Resistance (OR 0.78; 95% CI, 0.25–2.40 p = 0.66), and Persistence after 3 days (OR 0.88; 95% CI, 0.35–2.18 p = 0.78) were not significantly different between the groups. In other words, patients with ARC have the same rate of resistance and persistence of pathogen after three days. There was no difference in the 30-day mortality between the two groups (OR 0.22; 95% CI, 0.04–1.40 p = 0.11). Also, there was no difference in the ICU length of stay (LOS) nor in hospital LOS between the two groups (22.0 days vs. 17.5 days, p = 0.37), and (51.0 days vs. 30.0 days, p = 0.07) respectively. Conclusion: Using standard dosing of hydrophilic broad-spectrum antibiotics in ARC patients was not inferior to non-ARC patients in terms of the pathogen eradication, resistance, and persistence. Further randomized clinical and interventional studies are required to confirm our findings.

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An adjustment of vancomycin dosing regimen for a young patient with augmented renal clearance: A case report / Úprava dávkového režimu vankomycínu pre mladého pacienta so zvýšeným renálnym klírensom: Kazuistika

Acta Facultatis Pharmaceuticae Universitatis Comenianae ◽

10.1515/afpuc-2015-0025 ◽

2015 ◽

Vol 62 (2) ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Maria Goboova ◽

Magdalena Kuzelova ◽

Viera Kissova ◽

Dasa Bodakova ◽

Elena Martisova

Keyword(s):

Case Report ◽

Young Patient ◽

Renal Clearance ◽

Critically Ill ◽

Critically Ill Patients ◽

Crush Syndrome ◽

Therapeutic Drug ◽

Renal Elimination ◽

Augmented Renal Clearance ◽

Conventional Dose

AbstractAugmented renal clearance (ARC) is a recently reported condition in pathophysiology of critically ill patients in the intensive care unit. ARC refers to the enhanced renal elimination of circulating solutes. These patients are either young or previously healthy people who have undergone surgery or multiple trauma.This case report describes an adjustment of dosing regime of vancomycin to a young patient, who demonstrated ARC with severe polytrauma, overcome crush syndrome and sepsis. This 16-year old male patient was crushed by a tractor, which caused severe tissue damaged in the right lower limb. He gradually developed a serious crush syndrome. When kidneys resumed their function, creatinine clearance reached the value that indicated ARC (339.81 mL/min/1.73 m2). Vancomycin was included in the patient’s treatment regime by administering conventional dose of 1 g per 12 hours. The residual measured levels were very low. The dose of vancomycin had to be adjusted to double and then to triple the conventional dose. Without the therapeutic drug monitoring (TDM) and subsequent interpretation of the results by the clinical pharmacists, such high doses would not have been considered for administration.ARC responds strongly to sub-therapeutic serum vancomycin levels. Our case report confirms the significance of TDM and the consecutive interpretation of the results in critically ill patients.

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