Augmented renal clearance in Japanese intensive care unit patients: a prospective study

Kawano, Yasumasa; Morimoto, S.; Izutani, Yoshito; Muranishi, Kentaro; Kaneyama, Hironari; Hoshino, Kota; Nishida, Takeshi; Ishikura, Hiroyasu

doi:10.1186/s40560-016-0187-7

Cited by 31 publications

(31 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a previous trial of febrile neutropenic patients, we observed that 31% of the study cohort exhibited ARC. This is comparable to other reports for intensive care unit (ICU) patients: 33% by Ruiz et al (26), 38.7% by Kawano et al (27), and 28% by Campassi et al (28). A higher incidence in ICU patients was also reported by other authors, e.g., 55.8% (29) and 65.1% (30).…”

Section: Discussionsupporting

confidence: 88%

Using Population Pharmacokinetic Modeling and Monte Carlo Simulations To Determine whether Standard Doses of Piperacillin in Piperacillin-Tazobactam Regimens Are Adequate for the Management of Febrile Neutropenia

Sime

Hahn

Warner

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Changes in the pharmacokinetics of piperacillin in febrile neutropenic patients have been reported to result in suboptimal exposures. This study aimed to develop a population pharmacokinetic model for piperacillin and perform dosing simulation to describe optimal dosing regimens for hematological malignancy patients with febrile neutropenia. Concentration-time data were obtained from previous prospective observational pharmacokinetic and interventional therapeutic drug monitoring studies. Nonparametric population pharmacokinetic analysis and Monte Carlo dosing simulations were performed with the Pmetrics package for R. A twocompartment model, with between-subject variability for clearance (CL), adequately described the data from 37 patients (21 males, age of 59 Ϯ 12 years [means Ϯ standard deviations] and weight of 77 Ϯ 16 kg). Parameter estimates were CL of 18.0 Ϯ 4.8 liters/h, volume of distribution of the central compartment of 14.3 Ϯ 7.3 liters, rate constant for piperacillin distribution from the central to peripheral compartment of 1.40 Ϯ 1.35 h Ϫ1 , and rate constant for piperacillin distribution from the peripheral to central compartment of 4.99 Ϯ 7.81 h Ϫ1 . High creatinine clearance (CL CR ) was associated with reduced probability of target attainment (PTA). Extended and continuous infusion regimens achieved a high PTA of Ͼ90% for an unbound concentration of piperacillin remaining above the MIC (fT ϾMIC ) of 50%. Only continuous regimens achieved Ͼ90% PTA for 100% fT ϾMIC when CL CR was high. The cumulative fraction of response (FTA, for fractional target attainment) was suboptimal (Ͻ85%) for conventional regimens for both empirical and directed therapy considering 50% and 100% fT ϾMIC . FTA was maximized with prolonged infusions. Overall, changes in piperacillin pharmacokinetics and the consequences on therapeutic dosing requirements appear similar to those observed in intensive care patients. Guidelines should address the altered dosing needs of febrile neutropenic patients exhibiting high CL CR or with known/presumed infections from high-MIC bacteria.KEYWORDS febrile neutropenia, piperacillin, population pharmacokinetics

show abstract

Section: Discussionsupporting

confidence: 88%

Using Population Pharmacokinetic Modeling and Monte Carlo Simulations To Determine whether Standard Doses of Piperacillin in Piperacillin-Tazobactam Regimens Are Adequate for the Management of Febrile Neutropenia

Sime

Hahn

Warner

et al. 2017

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…Instead, we used the eGFR values which were calculated by a Japanese equation for evaluating ARC. This Japanese equation has been reported to underestimate the GFR in ICU settings [10]. In addition, other commonly used formulas (such as CG, MDRD, and CKD-EPI) for eGFR worldwide have also been shown to underestimate the actual measured CrCl in ARC patients [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study

Kawano¹,

Maruyama²,

Hokama³

et al. 2018

PLoS ONE

Self Cite

View full text Add to dashboard Cite

Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.

show abstract

“…The Japanese eGFR equation(J-eGFR) [17] For males: eGFR (mL/min) = 194 ×SCr -1.094 ×age -0.287 For females: eGFR (mL/min) = 194 ×SCr -1.094 ×age -0.287 ×0.739…”

Section: Chronic Kidney Disease Epidemiology Collaboration Equation Fmentioning

confidence: 99%

Augmented Renal Clearance in Chinese Intensive Care Unit Patients After Traumatic Brain Injury: Identifying Estimate Glomerular Filtration Rate Cut-off Value as a Risk Factor

Dang

Guo

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundAugmented renal clearance (ARC) is common in trauma patients and associated with subtherapeutic antimicrobial concentrations. China has more patients with traumatic brain injury (TBI) than most other countries in the world. However, there were no studies that focus on the ARC in Chinese TBI patients. In this study, we report the incidence of ARC in patients with TBI as well as risk factors for ARC. Besides, we evaluated the ability of four commonly used estimate glomerular filtration rate (eGFR) formulas and other covariates to predict the presence of ARC.MethodsThe prospective observational study was conducted in a 24-bed tertiary level, university-affiliated hospital, and 54 TBI patients with normal serum creatinine enrolled. We measured 24-h creatinine clearance after admission, and ARC defined as measured creatinine clearance ≥ 130 ml/min/1.73 m2. Demographic variables were then compared, and multivariate analysis was performed. Receiver operating curve, bias, and precision analyses were conducted to examine eGFR and ARCTIC score accuracy in predicting ARC. Multiple logistic regression analysis was performed to estimate the risk factors contributing to ARC. ResultsThe incidence of ARC was 50%. A moderate correlation was shown between measured Crcl and four eGFR (rs/r was 0.590, 0.499, 0.404, and 0.518, respectively). All of the equations significantly underestimated the measured Crcl, especially in the ARC group. Neither had excellent precision for clinical application in this setting. ARCTIC score can't accurately distinguish ARC either. Multivariable analysis displayed that four factors independently correlated to ARC: male, larger BMI, lower serum creatinine, and without a history of hypertension. Further investigation found eGFR higher than the threshold, without a history of hypertension, and/or bigger BMI were independent risk factors for ARC, and they had good accuracy in predicting the occurrence of ARC.ConclusionsARC was frequently observed in Chinese TBI patients. The estimated methods of GFR and ARCTIC score inaccurate and couldn't be directly used as a screening tool to identify ARC in Chinese TBI patients. But if we take the cut-off values of different formulas into account, the estimated GFR could be used as a decisive risk factor in helping to screen the ARC.

show abstract

Augmented renal clearance in Japanese intensive care unit patients: a prospective study

Cited by 31 publications

References 35 publications

Using Population Pharmacokinetic Modeling and Monte Carlo Simulations To Determine whether Standard Doses of Piperacillin in Piperacillin-Tazobactam Regimens Are Adequate for the Management of Febrile Neutropenia

Using Population Pharmacokinetic Modeling and Monte Carlo Simulations To Determine whether Standard Doses of Piperacillin in Piperacillin-Tazobactam Regimens Are Adequate for the Management of Febrile Neutropenia

Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study

Augmented Renal Clearance in Chinese Intensive Care Unit Patients After Traumatic Brain Injury: Identifying Estimate Glomerular Filtration Rate Cut-off Value as a Risk Factor

Contact Info

Product

Resources

About