Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit

Adnan, S., Ratnam, S., Kumar, S., Paterson, D., Lipman, J., Roberts, J. and Udy, A. A. (2014) Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit. Anaesthesia And Intensive Care, 42 6: 715-722.

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Author Adnan, S.
Ratnam, S.
Kumar, S.
Paterson, D.
Lipman, J.
Roberts, J.
Udy, A. A.
Title Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit
Journal name Anaesthesia And Intensive Care   Check publisher's open access policy
ISSN 0310-057X
1448-0271
Publication date 2014-11-01
Year available 2014
Sub-type Article (original research)
Open Access Status Not yet assessed
Volume 42
Issue 6
Start page 715
End page 722
Total pages 8
Place of publication North Sydney, NSW Australia
Publisher Australian Society of Anaesthetists
Language eng
Abstract Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated,creatinine clearances in this group. Patients with an expected ICU stay of >24 hours plus an admission serum creatinine concentration <120 mu mol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Cr-cl) and measured Cr-cl. Bias was larger in ARC patients, with Cockcroft-Gault Cr-cl being significantly lower than measured Cr-cl (P < 0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with 'normal' serum creatinine concentrations have varied Cr-cl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Cr-cl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.
Formatted abstract
Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of >24 hours plus an admission serum creatinine concentration <120 µmol/l, were enrolled from May to July 2013. Twenty-four hour urinary collections and serum creatinine concentrations were used to measure creatinine clearance. A total of 49 patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P <0.01) and demonstrating poor correlation (rs=-0.04). In conclusion, critically ill patients with ‘normal’ serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.
Keyword Antibiotic dosing
Augmented renal clearance
Creatinine clearance
Critical illness
Glomerular filtration rate
Q-Index Code C1
Q-Index Status Confirmed Code
Grant ID NHMRC APP1048652
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
 
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