scholarly journals Augmented renal clearance in critically ill patients with cancer (ARCCAN Study): A prospective observational study evaluating prevalence and risk factors

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Lama H. Nazer ◽  
Aseel K. AbuSara ◽  
Yasmeen Kamal
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Augmented Renal Clearance ◽  
Patients With Cancer

scholarly journals Augmented Renal Clearance in Critically Ill Patients with Sepsis: Prevalence, Risk Factors and Outcome

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Shahir Asraf bin Abdul Rahim ◽  
Azrina Md Ralib ◽  
Abdul Hadi Mohamad ◽  
Ariff Osman ◽  
Mohd Basri Mat Nor
Keyword(s):  
Risk Factors ◽  
Cardiac Index ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Estimated Glomerular Filtration Rate ◽  
Inclusion Criteria ◽  
Augmented Renal Clearance

Introduction: Augmented renal clearance (ARC) is a phenomenon where there is elevated renal clearance and defined by creatinine clearance more than 130ml/min. ARC results in changes of the pharmacokinetic and pharmacodynamic of antimicrobial therapy being administered, which may result in its subtherapeutic dose. We evaluated the prevalence, risk factors and outcome of ARC in critically ill patients with sepsis. Materials and method: This is an interim analysis of single centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis with plasma creatinine less than 130 µmol/l. Urinary creatinine and flow rate were measured and creatinine clearance (CrCl) calculated.ARC is defined as CrCl of more 130 ml/min. Ultrasonic cardiac output montoring (USCOM) was used to measure cardiac index. Results: Nineteen patients were analysed so far, of which 11 (57.9%) had ARC. There were no differences age, gender, or category of patients between patients with and without ARC. Baseline APACHE II and SOFA score were similar in the two groups (p=0.47 and 0.06, respectively).There was no difference in the hospital mortality (p=0.86). However, duration of ICU admission amongst survivors was longer in patients with ARC (10 (5-12) vs 4 (3-5) days, p=0.04). Of the 11 with ARC, 7 persisted to day 2. Measured creatinine clearance correlated well with the estimated glomerular filtration rate (r=0.68, p<0.0001), however it did not correlate with cardiac index (r=0.40, p=0.14). Conclusion: ARC occurs in almost half of critically ill patients with sepsis, and is associated with longer duration of ICU stay. However, there was no difference in the outcome in this small study. Future larger study may be important to investigate this.

Prevalence and Risk Factors for Augmented Renal Clearance in a Population of Critically Ill Patients

2018 ◽  
Vol 35 (10) ◽  
pp. 1044-1052 ◽  
Author(s):  
João Pedro Baptista ◽  
Paulo Jorge Martins ◽  
Margarida Marques ◽  
Jorge Manuel Pimentel
Keyword(s):  
Risk Factors ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Augmented Renal Clearance ◽  
Saps Ii ◽  
Male Sex

Background: Critically ill patients show a high, albeit variable, prevalence of augmented renal clearance (ARC). This condition has relevant consequences on the elimination of hydrophilic drugs. Knowledge of risk factors for ARC helps in the early identification of ARC. The aims of this study were evaluation of (1) risk factors for ARC and (2) the prevalence of ARC in critically ill patients over a period of 1 year. Methods: A retrospective cohort study was performed for all consecutive patients admitted to our intensive care unit (ICU). Augmented renal clearance was defined by a creatinine clearance ≥130 mL/min/1.73 m2. “Patient with ARC” was defined as a patient with a median of creatinine clearance ≥130 mL/min/1.73 m2 over the period of admission. Four variables were tested, Simplified Acute Physiology Score II (SAPS II), male gender, age, and trauma as cause for ICU admission. An analysis (patient based and clearance based) was performed with logistic regression. Results: Of 475 patients, 446 were included in this study, contributing to 454 ICU admissions and 5586 8-hour creatinine clearance (8h-CLCR). Overall, the prevalence of patients with ARC was 24.9% (n = 113). In a subset of patients with normal serum creatinine levels, the prevalence was 43.0% (n = 104). Of the set of all 8h-CLCR measurements, 25.4% (1418) showed ARC. In the patient-based analysis, the adjusted odds ratio was: 2.0 (confidence interval [CI]:1.1-3.7; P < .05), 0.93 (CI: 0.91-0.94; P < .01), 2.7 (CI: 1.4-5.3; P < .01), and 0.98 (CI: 0.96 -1.01; P = .15), respectively, for trauma, age, male sex, and SAPS II. In the clearance-based analysis, the adjusted odds ratio were 1.7 (CI: 1.4-1.9; P < .01), 0.94 (CI: 0.932-0.942; P < .01), and 2.9 (CI: 2.4-3.4; P < .01), respectively, for trauma, age, and male sex. Conclusions: Trauma, young age, and male sex were independent risk factors for ARC. This condition occurs in a considerable proportion of critical care patients, which was particularly prevalent in patients without evidence of renal dysfunction.

scholarly journals Augmented Renal Clearance in Critically Ill Patients in Malaysian Intensive Care Unit: Assessment of Prevalence, Risk Factors and Outcomes

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Shahir Asraf b Abdul Rahim ◽  
Azrina Md Ralib
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Plasma Creatinine ◽  
Augmented Renal Clearance ◽  
Younger Age

Introduction: Augmented renal clearance (ARC) is a phenomenon where there is elevated renal clearance and defined by creatinine clearance >130ml/min. ARC results in changes of the pharmacokinetic and pharmacodynamic of antimicrobial therapy being administered resulting in its subtherapeutic dose. We evaluated the prevalence, risk factors and outcome of ARC in critically ill patients in two Intensive Care Units (ICU) in Kuantan. Materials and Methods: This was a two centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 15 years old with plasma creatinine <130µmol/l, with arterial line and urinary catheter inserted. The creatinine clearance (CrCl) were measured using plasma creatinine, urinary creatinine and urinary flow rate. ARC is defined as CrCl of more 130ml/min. Results: Among 102 patients recruited, 57 (55.9%) had ARC. Those with younger age (39.9±19 years old, p=0.013) and lower SOFA score (2.8±2.6, p=0.012) had increased risk of developing ARC. No significant difference in other risk factors such as male and trauma were found. There was no difference in the ICU and hospital mortality (p=0.652 and p=0.128). There was also no difference in the duration of ICU admission amongst survivors with or without ARC (100.6±142.3). Measured CrCl correlated well with the estimated glomerular filtration rate (eGFR) using all four different eGFR equations (r=0.436 to 0.552, p<0.0001). Conclusion: ARC occurs in almost half of critically ill patients and more common in younger age and lower SOFA score. However, there was no difference in the outcome. eGFR may be used as surrogate in detecting ARC.

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