Augmented renal clearance. An unnoticed relevant event

Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze...

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Autores: Tomasa-Irriguible, Teresa Maria|||0000-0001-8033-8527, Sabater-Riera, Joan|||0000-0003-1246-5537, Pérez-Carrasco, Marcos|||0000-0001-7086-083X, Ortiz-Ballujera, Patricia, Díaz Buendia, Yolanda|||0000-0001-8221-7876, Navas Pérez, Ana Maria|||0000-0002-2860-4864, Betbesé Roig, Antoni Jordi|||0000-0002-9059-4046, Rodríguez-López, Miguel, Ibarz, Mercedes|||0000-0003-2908-0748, Olmo-Isasmendi, Aitor, Oliva-Zelaya, Iban, Rovira-Anglès, Conxita, Cano Hernández, Silvia|||0000-0002-9487-6673, Vendrell-Torra, Ester|||0000-0002-3967-8105, Catalan-Ibars, Rosa-María|||0000-0002-9455-1772, Miralbés-Torner, Mar, González de Molina, Francisco Javier|||0000-0002-2059-3400, Xirgú, Judith, Marcos Neira, Pilar
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:272013
Acceso en línea:https://ddd.uab.cat/record/272013
https://dx.doi.org/urn:doi:10.1177/00368504211018580
Access Level:acceso abierto
Palabra clave:Augmented renal clearance
ARC
Glomerular filtrate rate
GFR
Chronic Kidney Disease Epidemiology Collaboration formula
CKD-EPI
Critically ill patient
Prevalence
Descripción
Sumario:Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m. Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5-58.5) versus 66 (63.5-68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients.

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