Journal
ANAESTHESIA AND INTENSIVE CARE
Volume 42, Issue 6, Pages 715-722Publisher
AUSTRALIAN SOC ANAESTHETISTS
DOI: 10.1177/0310057X1404200606
Keywords
augmented renal clearance; critical illness; creatinine clearance; glomerular filtration rate; antibiotic dosing
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Funding
- National Health and Medical Research Council of Australia Research Fellowship [NHMRC APP1048652]
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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.
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