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Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing

Augmented renal clearance (ARC) is a manifestation of enhanced renal function seen in critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with ARC might lead to therapy failure. The purpose of this scoping review was to provide and up-to-date summary...

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Autores principales: Mahmoud, Sherif Hanafy, Shen, Chen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620577/
https://www.ncbi.nlm.nih.gov/pubmed/28926966
http://dx.doi.org/10.3390/pharmaceutics9030036
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author Mahmoud, Sherif Hanafy
Shen, Chen
author_facet Mahmoud, Sherif Hanafy
Shen, Chen
author_sort Mahmoud, Sherif Hanafy
collection PubMed
description Augmented renal clearance (ARC) is a manifestation of enhanced renal function seen in critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with ARC might lead to therapy failure. The purpose of this scoping review was to provide and up-to-date summary of the available evidence pertaining to the phenomenon of ARC. A literature search of databases of available evidence in humans, with no language restriction, was conducted. Databases searched were MEDLINE (1946 to April 2017), EMBASE (1974 to April 2017) and the Cochrane Library (1999 to April 2017). A total of 57 records were included in the present review: 39 observational studies (25 prospective, 14 retrospective), 6 case reports/series and 12 conference abstracts. ARC has been reported to range from 14 to 80%. ARC is currently defined as an increased creatinine clearance of greater than 130 mL/min/1.73 m(2) best measured by 8–24 h urine collection. Patients exhibiting ARC tend to be younger (<50 years old), of male gender, had a recent history of trauma, and had lower critical illness severity scores. Numerous studies have reported antimicrobials treatment failures when using standard dosing regimens in patients with ARC. In conclusion, ARC is an important phenomenon that might have significant impact on outcome in critically ill patients. Identifying patients at risk, using higher doses of renally eliminated drugs or use of non-renally eliminated alternatives might need to be considered in ICU patients with ARC. More research is needed to solidify dosing recommendations of various drugs in patients with ARC.
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spelling pubmed-56205772017-10-03 Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing Mahmoud, Sherif Hanafy Shen, Chen Pharmaceutics Review Augmented renal clearance (ARC) is a manifestation of enhanced renal function seen in critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with ARC might lead to therapy failure. The purpose of this scoping review was to provide and up-to-date summary of the available evidence pertaining to the phenomenon of ARC. A literature search of databases of available evidence in humans, with no language restriction, was conducted. Databases searched were MEDLINE (1946 to April 2017), EMBASE (1974 to April 2017) and the Cochrane Library (1999 to April 2017). A total of 57 records were included in the present review: 39 observational studies (25 prospective, 14 retrospective), 6 case reports/series and 12 conference abstracts. ARC has been reported to range from 14 to 80%. ARC is currently defined as an increased creatinine clearance of greater than 130 mL/min/1.73 m(2) best measured by 8–24 h urine collection. Patients exhibiting ARC tend to be younger (<50 years old), of male gender, had a recent history of trauma, and had lower critical illness severity scores. Numerous studies have reported antimicrobials treatment failures when using standard dosing regimens in patients with ARC. In conclusion, ARC is an important phenomenon that might have significant impact on outcome in critically ill patients. Identifying patients at risk, using higher doses of renally eliminated drugs or use of non-renally eliminated alternatives might need to be considered in ICU patients with ARC. More research is needed to solidify dosing recommendations of various drugs in patients with ARC. MDPI 2017-09-16 /pmc/articles/PMC5620577/ /pubmed/28926966 http://dx.doi.org/10.3390/pharmaceutics9030036 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Mahmoud, Sherif Hanafy
Shen, Chen
Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title_full Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title_fullStr Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title_full_unstemmed Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title_short Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing
title_sort augmented renal clearance in critical illness: an important consideration in drug dosing
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5620577/
https://www.ncbi.nlm.nih.gov/pubmed/28926966
http://dx.doi.org/10.3390/pharmaceutics9030036
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