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Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment

OBJECTIVE: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine t...

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Autores principales: Campassi, María Luz, Gonzalez, María Cecilia, Masevicius, Fabio Daniel, Vazquez, Alejandro Risso, Moseinco, Miriam, Navarro, Noelia Cintia, Previgliano, Luciana, Rubatto, Nahuel Paolo, Benites, Martín Hernán, Estenssoro, Elisa, Dubin, Arnaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Associação de Medicina Intensiva Brasileira 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031886/
https://www.ncbi.nlm.nih.gov/pubmed/24770684
http://dx.doi.org/10.5935/0103-507X.20140003
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author Campassi, María Luz
Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Vazquez, Alejandro Risso
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
author_facet Campassi, María Luz
Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Vazquez, Alejandro Risso
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
author_sort Campassi, María Luz
collection PubMed
description OBJECTIVE: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients. METHODS: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m(2)), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. RESULTS: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. CONCLUSIONS: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
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spelling pubmed-40318862014-06-02 Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment Campassi, María Luz Gonzalez, María Cecilia Masevicius, Fabio Daniel Vazquez, Alejandro Risso Moseinco, Miriam Navarro, Noelia Cintia Previgliano, Luciana Rubatto, Nahuel Paolo Benites, Martín Hernán Estenssoro, Elisa Dubin, Arnaldo Rev Bras Ter Intensiva Original Articles OBJECTIVE: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients. METHODS: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m(2)), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. RESULTS: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. CONCLUSIONS: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing. Associação de Medicina Intensiva Brasileira 2014 /pmc/articles/PMC4031886/ /pubmed/24770684 http://dx.doi.org/10.5935/0103-507X.20140003 Text en http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Campassi, María Luz
Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Vazquez, Alejandro Risso
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title_full Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title_fullStr Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title_full_unstemmed Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title_short Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
title_sort augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031886/
https://www.ncbi.nlm.nih.gov/pubmed/24770684
http://dx.doi.org/10.5935/0103-507X.20140003
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