Reliability of serum creatinine‐based formulae estimating renal function in non‐critically ill surgery patients: Focus on augmented renal clearance

Declercq, Peter; Gijsen, Matthias; Meijers, Björn; Schetz, Marie; Nijs, Stefaan; D’Hoore, André; Wauters, Joost; Spriet, Isabel

doi:10.1111/jcpt.12695

Cited by 9 publications

(2 citation statements)

References 30 publications

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“…Different studies assessed the performances of eGFR equations compared to mCL CR across different ranges of GFR, and almost all showed important flaws when using such mathematical equations for renal function estimation in critically ill patients [ 22 , 23 , 24 , 25 ]. A recent retrospective study conducted on 237 critically ill patients in Arabia with a mean mCL CR of 102.7 ± 65.4 mL/min showed that eGFR CKDEPI , eGFR CG , and eGFR MDRD had an accuracy as low as 12.7–30% in estimating mCL CR within ±10%, and that both eGFR CG and eGFR MDRD , but not eGFR CKDEPI , were significantly biased.…”

Section: Discussionmentioning

confidence: 99%

Measuring Creatinine Clearance Is the Most Accurate Way for Calculating the Proper Continuous Infusion Meropenem Dose for Empirical Treatment of Severe Gram-Negative Infections among Critically Ill Patients

et al. 2023

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Assessment of glomerular filtration rate (GFR) is necessary for dose adjustments of beta-lactam that are excreted by the kidneys, such as meropenem. The aim of this study was to compare the daily dose of 24 h-continuous infusion (CI) meropenem when GFR was calculated by means of measured creatinine clearance (mCLCR) or estimated by the CKDEPI (eGFRCKDEPI), Cockcroft–Gault (eGFRCG), and MDRD (eGFRMDRD) equations. Adult critically ill patients who underwent therapeutic drug monitoring (TDM) for the assessment of 24 h-CI meropenem steady state concentration (Css) and for whom a 24 h-urine collection was performed were retrospectively enrolled. Meropenem clearance (CLM) was regressed against mCLCR, and meropenem daily dose was calculated based on the equation infusion rate = daily dose/CLM. eGFRCKDEPI, eGFRCG, and eGFRCKDEPI were regressed against mCLCR in order to estimate CLM. Forty-six patients who provided 133 meropenem Css were included. eGFRCKDEPI overestimated mCLCR up to 90 mL/min, then mCLCR was underestimated. eGFRCG and eGFRMDRD overestimated mCLCR across the entire range of GFR. In critically ill patients, dose adjustments of 24 h-CI meropenem should be based on mCLCR. Equations for estimation of GFR may lead to gross under/overestimates of meropenem dosages. TDM may be highly beneficial, especially for critically ill patients with augmented renal clearance.

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Section: Discussionmentioning

confidence: 99%

Measuring Creatinine Clearance Is the Most Accurate Way for Calculating the Proper Continuous Infusion Meropenem Dose for Empirical Treatment of Severe Gram-Negative Infections among Critically Ill Patients

et al. 2023

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“…Moreover, beta-lactam optimization by means of TDM may acquire special relevance for patients with augmented renal function, a condition that often occurs in oncohematologic patients [ 48 ]. In this patient population, dose adjustments should be based on measured rather than estimated renal function, as eGFR has been reported to either underestimate or overestimate measured creatinine clearance in different studies [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Does Cytokine-Release Syndrome Induced by CAR T-Cell Treatment Have an Impact on the Pharmacokinetics of Meropenem and Piperacillin/Tazobactam in Patients with Hematological Malignancies? Findings from an Observational Case-Control Study

et al. 2023

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Chimeric antigen receptor (CAR) T-cell therapy is a promising approach for some relapse/refractory hematological B-cell malignancies; however, in most patients, cytokine release syndrome (CRS) may occur. CRS is associated with acute kidney injury (AKI) that may affect the pharmacokinetics of some beta-lactams. The aim of this study was to assess whether the pharmacokinetics of meropenem and piperacillin may be affected by CAR T-cell treatment. The study included CAR T-cell treated patients (cases) and oncohematological patients (controls), who were administered 24-h continuous infusion (CI) meropenem or piperacillin/tazobactam, optimized by therapeutic drug monitoring, over a 2-year period. Patient data were retrospectively retrieved and matched on a 1:2 ratio. Beta-lactam clearance (CL) was calculated as CL = daily dose/infusion rate. A total of 38 cases (of whom 14 and 24 were treated with meropenem and piperacillin/tazobactam, respectively) was matched with 76 controls. CRS occurred in 85.7% (12/14) and 95.8% (23/24) of patients treated with meropenem and piperacillin/tazobactam, respectively. CRS-induced AKI was observed in only 1 patient. CL did not differ between cases and controls for both meropenem (11.1 vs. 11.7 L/h, p = 0.835) and piperacillin (14.0 vs. 10.4 L/h, p = 0.074). Our findings suggest that 24-h CI meropenem and piperacillin dosages should not be reduced a priori in CAR T-cell patients experiencing CRS.

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Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures

Declercq

Zalavras

Nijssen

et al. 2020

Arch Orthop Trauma Surg

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Reliability of serum creatinine‐based formulae estimating renal function in non‐critically ill surgery patients: Focus on augmented renal clearance

Abstract: In surgical patients, eGFR frequently underestimates measured CrCl, especially in young patients with low ASA score. eGFR cut-offs predicting ARC were identified.

Cited by 9 publications

References 30 publications

Measuring Creatinine Clearance Is the Most Accurate Way for Calculating the Proper Continuous Infusion Meropenem Dose for Empirical Treatment of Severe Gram-Negative Infections among Critically Ill Patients

Measuring Creatinine Clearance Is the Most Accurate Way for Calculating the Proper Continuous Infusion Meropenem Dose for Empirical Treatment of Severe Gram-Negative Infections among Critically Ill Patients

Does Cytokine-Release Syndrome Induced by CAR T-Cell Treatment Have an Impact on the Pharmacokinetics of Meropenem and Piperacillin/Tazobactam in Patients with Hematological Malignancies? Findings from an Observational Case-Control Study

Impact of duration of perioperative antibiotic prophylaxis on development of fracture-related infection in open fractures

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