Augmented renal clearance in the ICU: Results of a Multicenter observational study of renal function in critically ill patients with normal plasma Creatinine concentrations

Udy, Andrew A., Baptista, Joao P., Lim, Noelle L., Joynt, Gavin M., Jarrett, Paul, Wockner, Leesa, Boots, Robert J. and Lipman, Jeffrey (2014) Augmented renal clearance in the ICU: Results of a Multicenter observational study of renal function in critically ill patients with normal plasma Creatinine concentrations. Critical Care Medicine, 42 3: 520-527. doi:10.1097/CCM.0000000000000029


Author Udy, Andrew A.
Baptista, Joao P.
Lim, Noelle L.
Joynt, Gavin M.
Jarrett, Paul
Wockner, Leesa
Boots, Robert J.
Lipman, Jeffrey
Title Augmented renal clearance in the ICU: Results of a Multicenter observational study of renal function in critically ill patients with normal plasma Creatinine concentrations
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000000029
Open Access Status DOI
Volume 42
Issue 3
Start page 520
End page 527
Total pages 8
Place of publication Baltimore, MD United States
Publisher Lippincott Williams and Wilkins
Collection year 2015
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract OBJECTIVE:: To describe the prevalence and natural history of augmented renal clearance in a cohort of recently admitted critically ill patients with normal plasma creatinine concentrations. DESIGN:: Multicenter, prospective, observational study. SETTING:: Four, tertiary-level, university-Affiliated, ICUs in Australia, Singapore, Hong Kong, and Portugal. PATIENTS:: Study participants had to have an expected ICU length of stay more than 24 hours, no evidence of absolute renal impairment (admission plasma creatinine < 120 μmol/L), and no history of prior renal replacement therapy or chronic kidney disease. Convenience sampling was used at each participating site. INTERVENTIONS:: Eight-hour urinary creatinine clearances were collected daily, as the primary method of measuring renal function. Augmented renal clearance was defined by a creatinine clearance more than or equal to 130 mL/min/1.73 m. Additional demographic, physiological, therapeutic, and outcome data were recorded prospectively. MEASUREMENTS AND MAIN RESULTS:: Nine hundred thirty-two patients were admitted to the participating ICUs over the study period, and 281 of which were recruited into the study, contributing 1,660 individual creatinine clearance measures. The mean age (95% CI) was 54.4 years (52.5-56.4 yr), Acute Physiology and Chronic Health Evaluation II score was 16 (15.2-16.7), and ICU mortality was 8.5%. Overall, 65.1% manifested augmented renal clearance on at least one occasion during the first seven study days; the majority (74%) of whom did so on more than or equal to 50% of their creatinine clearance measures. Using a mixed-effects model, the presence of augmented renal clearance on study day 1 strongly predicted (p = 0.019) sustained elevation of creatinine clearance in these patients over the first week in ICU. CONCLUSIONS:: Augmented renal clearance appears to be a common finding in this patient group, with sustained elevation of creatinine clearance throughout the first week in ICU. Future studies should focus on the implications for accurate dosing of renally eliminated pharmaceuticals in patients with augmented renal clearance, in addition to the potential impact on individual clinical outcomes. Copyright
Keyword Augmented renal clearance
Creatinine Clearance
Critical Illness
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
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