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. 2013 Oct;28(5):695-700.
doi: 10.1016/j.jcrc.2013.03.003. Epub 2013 May 14.

Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy

Barbara O M Claus  1 , Eric A Hoste, Kirsten Colpaert, Hugo Robays, Johan Decruyenaere, Jan J De Waele
Affiliations

Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy

Barbara O M Claus et al. J Crit Care. 2013 Oct.

Abstract

Introduction: We describe incidence and patient factors associated with augmented renal clearance (ARC) in adult intensive care unit (ICU) patients.

Materials and methods: A prospective observational study in a mixed cohort of surgical and medical ICU patients receiving antimicrobial therapy at the Ghent University Hospital, Belgium. Kidney function was assessed by the 24-hour creatinine clearance (Ccr); ARC defined as at least one Ccr of >130 mL/min per 1.73 m2. Multivariate logistic regression analysis: to assess variables associated with ARC occurrence. Therapeutic failure (TF): an impaired clinical response and need for alternate antimicrobial therapy.

Results: Of the 128 patients and 599 studied treatment days, ARC was present in 51.6% of the patients. Twelve percent permanently expressed ARC. ARC patients had a median Ccr of 144 mL/min per 1.73 m2 (IQR 98-196). Median serum creatinine concentration on the first day of ARC was 0.54 mg/dL (IQR 0.48-0.69). Patients with ARC were significantly younger (P<.001). Age and male gender were independently associated with ARC whereas the APACHE II score was not. ARC patients had more TF (18 (27.3%) vs. 8 (12.9%); P=.04).

Conclusion: ARC was documented in approximately 52% of a mixed ICU patient population receiving antibiotic treatment with worse clinical outcome. Young age and male gender were independently associated with ARC presence.

Keywords: 24-hour creatinine clearance; APACHE II; ARC; Acute Physiology and Chronic Health Evaluation II; Antibiotic underdosing; Augmented renal clearance; BSA; Body surface area; CI; CKD-EPI; Ccr; Chronic Kidney Disease Epidemiology Collaboration; Continuous infusion; Creatinine clearance; EI; Extended infusion; GFR; Glomerular filtration rate; Glomerular hyperfiltration; IQR; Interquartile range; LOS; Length of stay; MDRD; MICU; Medical Intensive Care Unit; Modifying Diet in Renal Disease; PDMS; Patient Data Management System; SICU; Scr; Serum creatinine concentration; Surgical Intensive Care Unit; U(cr); U(vol); Urinary creatinine concentration; Urinary volume.

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