Predicting augmented renal clearance using estimated glomerular filtration rate in critically-ill children

Lee, Bong Jin; Kim, Jongyoon; Park, June Dong; Cho, Yoon Sook; Kim, Kwi Suk

doi:10.5414/cn109216

Cited by 18 publications

(13 citation statements)

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“…Review of titles and abstracts led to the retrieval of 215 potentially relevant full‐text citations. After full‐text review, 25 citations met the criteria for inclusion 16–41 . The most common reason for exclusion was non‐pediatric population studies (190 citations), followed by lack of ARC data (24 citations).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes the characteristics of the studies included based upon their primary objective 16–41 . The first articles related to ARC in pediatrics were published in 2015 and were pharmacokinetic objective studies 20,36 .…”

Section: Resultsmentioning

confidence: 99%

“…In 2019, the first articles were published that evaluated general information related to ARC in pediatric patients 16,28,34 . Most of the published work (84%) has described the impact of ARC on pharmacokinetic/pharmacodynamic alterations in antimicrobial agents 18–22,24–27,29–33,35–41 . The 25 citations, representing a total of 2102 patients, were published across 22 different journals, with only two journals having more than one published article related to ARC: Pediatric Nephrology and Antimicrobial Agents and Chemotherapy .…”

Section: Resultsmentioning

confidence: 99%

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Scoping review of augmented renal clearance in critically ill pediatric patients

2021

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Augmented renal clearance (ARC), a phenomenon of enhanced elimination of renal solutes, has been described in adult critically ill patients, but little is known about the phenomenon in children. The aim of this scoping review was to gather and summarize all evidence on ARC in pediatric patients to examine its breadth and depth including prevalence, risk factors, and pharmacokinetic alterations and identify any gaps for further areas of inquiry. PubMed, Embase, and Web of Science were searched for titles, abstracts, or keywords that focused on ARC. Non‐English studies, reviews, and nonhuman studies were excluded. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐ScR) guidelines. Data were extracted on article type, study details, patient population, ARC definition and prevalence, methods of renal function assessment, and study results. A total of 215 citations were found with 25 citations meeting the criteria for inclusion in pediatrics (2102 total patients); the majority of studies (84%) focused on pharmacokinetics (PK) of antimicrobial agents. The median/mean age range was 1.25–12 years. There were a total of 10 different definitions of ARC. The prevalence of ARC ranged from 7.8% to 78%. The most common method for documenting creatinine clearance (CrCl) was the modified Schwartz equation (64%). Only 20% of studies reported risk factors for ARC including low serum creatinine, increasing age, febrile neutropenia, male, septic shock, and treatment with antibiotics. Glycopeptide antimicrobials were the most evaluated class (42.9%) among the 21 antimicrobial drug studies. All studies reported increased drug clearance and/or poor probability of achieving target concentrations of the agents studied. ARC showed variable prevalence in pediatric patients likely due to the lack of a standard definition and many studies not considering age‐related changes in CrCl with pediatric intensive care unit (PICU) patients. ARC was shown to impact PK of antibiotics commonly administered to pediatric patients, which may necessitate changes in standard dosing regimens.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Scoping review of augmented renal clearance in critically ill pediatric patients

2021

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“…As eGFR values differ according to the formula, the ARC varies similarly. Paediatric literature indicates that values vary between 12 and 75% 25,34–36 . All of these studies used the Schwartz formula.…”

Section: Discussionmentioning

confidence: 99%

Estimation of piperacillin clearance with different glomerular filtration rate formulas in critically ill children

Béranger

Benaboud

Urien

et al. 2020

Brit J Clinical Pharma

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Aims Glomerular filtration rate (GFR) is difficult to assess in critically ill children using gold standard method and alternatives are needed. This study aimed to determine the most accurate GFR estimation formula for assessing piperacillin clearance in critically ill children, using a published piperacillin pharmacokinetics (PK) population model. Methods All children hospitalized in the paediatric intensive care unit of a single institution who were receiving piperacillin were included. PK were described using the nonlinear mixed effect modelling software MONOLIX. In the initial PK model, GFR was estimated according to the Schwartz 1976 formula. We evaluated a set of 12 additional validated formulas, developed using plasma creatinine and/or cystatin C concentrations, in the building model to assess the lowest between‐subject variability for piperacillin clearance. Results We included 20 children with a median (range) postnatal age of 1.9 (0.1–19) years, body weight of 12.5 (3.5–69) kg. Estimated GFR according to the Schwartz 1976 formula was 160.5 (38–315) mL min−1 1.73 m−2. Piperacillin clearance was best predicted by the Bouvet combined formula. Conclusion The combined Bouvet formula was the most accurate GFR estimation formula for assessing piperacillin clearance in critically ill children.

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“…Several studies have also reported subtherapeutic vancomycin exposure in critically ill children with ARC [52,56,64,[111][112][113][114][115]. Increased loading or initial doses have been recommended to achieve early therapeutic exposure.…”

Section: Subpopulations Of Critically Ill Children and Neonates At Increased Risk Of Pharmacokinetic Alterations 41 Augmented Renal Clearmentioning

confidence: 99%

Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine

et al. 2021

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Children show important developmental and maturational changes, which may contribute greatly to pharmacokinetic (PK) variability observed in pediatric patients. These PK alterations are further enhanced by disease-related, non-maturational factors. Specific to the intensive care setting, such factors include critical illness, inflammatory status, augmented renal clearance (ARC), as well as therapeutic interventions (e.g., extracorporeal organ support systems or whole-body hypothermia [WBH]). This narrative review illustrates the relevance of both maturational and non-maturational changes in absorption, distribution, metabolism, and excretion (ADME) applied to antibiotics. It hereby provides a focused assessment of the available literature on the impact of critical illness—in general, and in specific subpopulations (ARC, extracorporeal organ support systems, WBH)—on PK and potential underexposure in children and neonates. Overall, literature discussing antibiotic PK alterations in pediatric intensive care is scarce. Most studies describe antibiotics commonly monitored in clinical practice such as vancomycin and aminoglycosides. Because of the large PK variability, therapeutic drug monitoring, further extended to other antibiotics, and integration of model-informed precision dosing in clinical practice are suggested to optimise antibiotic dose and exposure in each newborn, infant, or child during intensive care.

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Predicting augmented renal clearance using estimated glomerular filtration rate in critically-ill children

Abstract: The eGFR correlates with the VTL, and the eGFR cutoff value can predict a subtherapeutic vancomycin level. eGFR is a reliable and efficient alternative to mGFR for identifying ARC. .

Cited by 18 publications

References 0 publications

Scoping review of augmented renal clearance in critically ill pediatric patients

Scoping review of augmented renal clearance in critically ill pediatric patients

Estimation of piperacillin clearance with different glomerular filtration rate formulas in critically ill children

Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine

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Predicting augmented renal clearance using estimated glomerular filtration rate in critically-ill children

Abstract: The eGFR correlates with the VTL, and the eGFR cutoff value can predict a subtherapeutic vancomycin level. eGFR is a reliable and efficient alternative to mGFR for identifying ARC. .

Cited by 18 publications

References 0 publications

Scoping review of augmented renal clearance in critically ill pediatric patients

Scoping review of augmented renal clearance in critically ill pediatric patients

Estimation of piperacillin clearance with different glomerular filtration rate formulas in critically ill children

Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine

Contact Info

Product

Resources

About

Abstract: The eGFR correlates with the VTL, and the eGFR cutoff value can predict a subtherapeutic vancomycin level. eGFR is a reliable and efficient alternative to mGFR for identifying ARC. .