Risk factors associated with augmented renal clearance in a mixed intensive care unit population: a retrospective study

Bing, Emily; Archambault, Kym; Sananikone, Alice; Nguyen, Kim-Dan; Fang, Yi Tong; Jabamikos, Caren; Gras, Cécile; Marsot, Amélie; Duceppe, Marc‐Alexandre; Perreault, Marc M.

doi:10.1007/s11096-022-01458-9

Cited by 4 publications

(1 citation statement)

References 42 publications

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“…We found that ARC occurred relatively early after ICU admission, which is opposed to the findings of Beunders et al, who found that ARC occurred late on median (IQR) day 28 (21–42) following ICU admission during COVID-19 infections [ 17 ], but is in line with the findings of previous studies in general ICU patients (the highest ARC prevalence was observed on day 5) and critically ill COVID-19 patients (the median (IQR) first day of ARC was day 2 (3–5) of ICU stay) [ 1 , 19 ]. Next, age was ranked as the third most important feature, which was expected since age has consistently shown a significant inverse association with ARC in many studies [ 7 , 9 , 10 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. Age might be more relevant in this patient population since it has been noticed that some COVID-19 variants are more prevalent in young patients [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 96%

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

et al. 2023

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The ARC predictor is a prediction model for augmented renal clearance (ARC) on the next intensive care unit (ICU) day that showed good performance in a general ICU setting. In this study, we performed a retrospective external validation of the ARC predictor in critically ill coronavirus disease 19 (COVID-19) patients admitted to the ICU of the University Hospitals Leuven from February 2020 to January 2021. All patient-days that had serum creatinine levels available and measured creatinine clearance on the next ICU day were enrolled. The performance of the ARC predictor was evaluated using discrimination, calibration, and decision curves. A total of 120 patients (1064 patient-days) were included, and ARC was found in 57 (47.5%) patients, corresponding to 246 (23.1%) patient-days. The ARC predictor demonstrated good discrimination and calibration (AUROC of 0.86, calibration slope of 1.18, and calibration-in-the-large of 0.14) and a wide clinical-usefulness range. At the default classification threshold of 20% in the original study, the sensitivity and specificity were 72% and 81%, respectively. The ARC predictor is able to accurately predict ARC in critically ill COVID-19 patients. These results support the potential of the ARC predictor to optimize renally cleared drug dosages in this specific ICU population. Investigation of dosing regimen improvement was not included in this study and remains a challenge for future studies.

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Section: Discussionmentioning

confidence: 96%

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

et al. 2023

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Personalized application of antimicrobial drugs in pediatric patients with augmented renal clearance: a review of literature

Xu,

Qu,

Teng

et al. 2023

Eur J Pediatr

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What is New in Augmented Renal Clearance in Septic Patients?

Baptista,

Moura,

Silva

et al. 2023

Curr Infect Dis Rep

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Purpose of Review In this narrative review encompassing relevant scientific publications regarding critically ill patients in the last 5 years, we discuss key questions regarding the concept, pathophysiology, identification, epidemiology, and implications of augmented renal clearance (ARC) in the treatment of sepsis. Recent Findings Mathematical estimates of renal function show low accuracy when evaluating renal function in the intensive care unit, jeopardizing the correct dosing of antimicrobials. The description of ARC in critically ill patients in several, distant geographical areas worldwide reveals that this condition is more frequent than anticipated. Several new risk factors have been recently reported, needing future confirmation. Pathophysiology is still largely unknown; however, intact kidney physiology, inflammatory mediators, and tubular secretion seem to play a role. Several studies have demonstrated the association between ARC and subtherapeutic levels of several β-lactams, vancomycin, and fluconazole. Lately, there have been recommendations of dosage regimen adjustments for patients with ARC, namely, through increases in total daily dose or prolonged infusion for various antimicrobials. Literature is scarce describing the influence of ARC on clinical outcomes of patients receiving antibiotics, and results are contradictory. Summary Growing body of evidence supports that measured creatinine clearance based on time-defined urine output is strongly recommended for the identification of ARC and for reliable evaluation of its prevalence and risk factors. Clinicians should be alert for the need to use off-label dosing of antimicrobials in septic patients showing ARC. Concise recommendations for antibiotic dosage regimens, based on clinical data, are still needed.

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Risk factors associated with augmented renal clearance in a mixed intensive care unit population: a retrospective study

Cited by 4 publications

References 42 publications

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

External Validation of the Augmented Renal Clearance Predictor in Critically Ill COVID-19 Patients

Personalized application of antimicrobial drugs in pediatric patients with augmented renal clearance: a review of literature

What is New in Augmented Renal Clearance in Septic Patients?

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