Augmented renal clearance in septic patients and implications for vancomycin optimisation

Baptista, João Pedro; Sousa, Eduardo; Martins, Paulo; Pimentel, Jorge

doi:10.1016/j.ijantimicag.2011.12.011

Cited by 172 publications

(143 citation statements)

References 19 publications

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“…In our study, logarithmic regression was adopted to estimate the correlation between steady-state trough concentration and CL cr , which was better than the linear regression reported by the previous literatures (Baptista et al 2012;Minkut_ e et al 2013). Furthermore, a recent study in critically ill patients with ARC and administration by continuous infusion showed that vancomycin plasma clearance was correlated significantly with the 8-hour CL cr (Baptista et al 2014).…”

Section: Discussionmentioning

confidence: 77%

“…Recently, a phenomenon 'augmented renal clearance' (ARC) referring to enhanced renal elimination of circulating solutes has received increasing attention. It exerts a hypermetabolic status, which may increase renal blood flow and glomerular filtration (Udy et al 2010a(Udy et al , 2011aBaptista et al 2012;Minkut_ e et al 2013). It has also been reported that some patients with normal serum creatinine concentration might display elevated glomerular filtration rates (Udy et al 2011b).…”

Section: Introductionmentioning

confidence: 99%

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Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Chu

Luo

et al. 2016

Pharmaceutical Biology

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Context: Augmented renal clearance (ARC) refers to enhanced renal elimination of circulating solute, and has attracted wide attention in recent years. Objective: This study evaluates the effects of ARC on serum vancomycin concentration in patients administered vancomycin. Materials and methods: This was a retrospective study in patients receiving vancomycin treatment at a dose of 1000 mg in every 12 h and undergoing serum monitoring admitted over a 2-year period (May 2013 to May 2015, in order to estimate the influence of ARC on serum vancomycin concentration. In this study, statistical comparisons were made on the results from patients grouped according to creatinine clearance (CL cr ). Results: One hundred forty-eight patients were enrolled in our study. The results showed that ARC patients were significantly younger, with a significantly lower S cr and higher GFR. The CL cr and steady-state trough concentrations of serum vancomycin exhibited a logarithmic correlation (Rs ¼ À0.699, R 2 ¼ 0.488, p < 0.01) in the patients included in our study. The trough vancomycin concentrations of 62.9% patients in high CL cr group were under 10 lg/mL. Discussion and conclusion: Since ARC was significantly associated with subtherapeutic serum vancomycin concentration, it was necessary to devise adjusted dosage regimens for these patients based on their CL cr .ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Chu

Luo

et al. 2016

Pharmaceutical Biology

View full text Add to dashboard Cite

show abstract

“…Of note, bias appeared to be greatest in emergent surgical and trauma admissions (Table 7.2), sub-groups where ARC has been previously well documented (84,88 (199,225), and clinical (104) implications. Unfortunately no readily accessible, pragmatic, error free measure of GFR is currently available.…”

Section: Discussionmentioning

confidence: 89%

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Udy¹

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“…Consequently, all of these factors lead to increased renal CL of some drugs, a phenomenon referred to as augmented renal clearance (ARC, defined as a creatinine clearance [CLCR] >130 mL/min). As hydrophilic antibiotics are predominantly cleared by the kidney, ARC in critically ill patients usually causes lower plasma concentrations [116][117][118][119][120][121][122][123][124].…”

Section: Increase In Cardiac Output and Augmented Renal Clearancementioning

confidence: 99%

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

Abdul‐Aziz¹,

Mohd²

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Severe sepsis is a major burden in the intensive care unit (ICU) with persistently high mortality rates. Optimization of antibiotic dosing has been suggested as an intervention to improve clinical outcomes for critically ill patients with severe sepsis. However, current antibiotic dosing guidelines may not be appropriate for these patients, as they rarely consider the altered physiology and illness severity associated with this population. Optimizing antibiotic dosing using pharmacokinetic (PK) and pharmacodynamic (PD) principles can address these critical illness-related changes and promote therapeutic success. Due to their wide spectrum of antibiotic activity and excellent safety profile, beta-lactam antibiotics are commonly used for severe infections in the ICU. Two alternative dosing approaches to traditional intermittent bolus (IB) dosing, namely continuous infusion (CI) and extended infusion (EI), have been suggested to maximize the therapeutic potential of these antibiotics in critically ill patients. Collectively, the two dosing approaches can also be referred as prolonged infusion (PI).This Thesis aims to better characterize the pharmacokinetics/pharmacodynamics (PK/PD) of betalactam antibiotics to determine whether there is any therapeutic advantage associated with PI dosing (CI and/or EI) as compared to IB dosing. This Thesis comprises of eight chapters. Chapter 1 is an introductory chapter which provides an overview of the published literature on the area of research. The discussion in Chapter 1 presents a theoretical framework behind the Thesis objectives. Chapter 1 concludes with the specific aims of this Thesis.Chapter 2 reports the findings of a prospective PK study which aimed to describe the population PK of doripenem in critically ill patients with sepsis and perform dosing simulations to develop clinically relevant dosing guidelines for these patients. Twelve critically ill participants receiving 500 mg of doripenem 8-hourly as a 1-hr infusion were enrolled. The volume of distribution (Vd) and clearance (CL) of doripenem in this patient cohort were substantially different than those usually described in non-critically patients. As current dosing guidelines were mostly derived from the non-critically ill, findings from this study suggest that the licensed "one-dose-fits-all" dosing for doripenem is unlikely to achieve optimal exposures in critically ill patients. Empirical use of PI dosing should be considered to account for PK and illness severity differences, particularly when less-susceptible pathogens are involved.ii Chapter 3 incorporates a published systematic review which compares the PK/PD data and clinical outcomes between CI and IB dosing to describe any potential merits supporting either of the two dosing approaches for critically ill patients. The findings suggest that beta-lactam CI may not be advantageous for all critically ill patients and may be beneficial in patients with severe infections.Chapter 4 describes the findings of a post hoc analysis on the Defining...

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Augmented renal clearance in septic patients and implications for vancomycin optimisation

Cited by 172 publications

References 19 publications

Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Application of vancomycin in patients with varying renal function, especially those with augmented renal clearance

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

Optimizing beta-lactam antibiotic dosing in critically ill patients: Prolonged infusion versus intermittent bolus administration

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