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Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study

Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the...

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Autores principales: Kawano, Yasumasa, Maruyama, Junichi, Hokama, Ryo, Koie, Megumi, Nagashima, Ryotaro, Hoshino, Kota, Muranishi, Kentaro, Nakashio, Maiko, Nishida, Takeshi, Ishikura, Hiroyasu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287846/
https://www.ncbi.nlm.nih.gov/pubmed/30532142
http://dx.doi.org/10.1371/journal.pone.0208742
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author Kawano, Yasumasa
Maruyama, Junichi
Hokama, Ryo
Koie, Megumi
Nagashima, Ryotaro
Hoshino, Kota
Muranishi, Kentaro
Nakashio, Maiko
Nishida, Takeshi
Ishikura, Hiroyasu
author_facet Kawano, Yasumasa
Maruyama, Junichi
Hokama, Ryo
Koie, Megumi
Nagashima, Ryotaro
Hoshino, Kota
Muranishi, Kentaro
Nakashio, Maiko
Nishida, Takeshi
Ishikura, Hiroyasu
author_sort Kawano, Yasumasa
collection PubMed
description Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m(2). Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.
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spelling pubmed-62878462018-12-28 Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study Kawano, Yasumasa Maruyama, Junichi Hokama, Ryo Koie, Megumi Nagashima, Ryotaro Hoshino, Kota Muranishi, Kentaro Nakashio, Maiko Nishida, Takeshi Ishikura, Hiroyasu PLoS One Research Article Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m(2). Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality. Public Library of Science 2018-12-10 /pmc/articles/PMC6287846/ /pubmed/30532142 http://dx.doi.org/10.1371/journal.pone.0208742 Text en © 2018 Kawano et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kawano, Yasumasa
Maruyama, Junichi
Hokama, Ryo
Koie, Megumi
Nagashima, Ryotaro
Hoshino, Kota
Muranishi, Kentaro
Nakashio, Maiko
Nishida, Takeshi
Ishikura, Hiroyasu
Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title_full Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title_fullStr Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title_full_unstemmed Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title_short Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study
title_sort outcomes in patients with infections and augmented renal clearance: a multicenter retrospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287846/
https://www.ncbi.nlm.nih.gov/pubmed/30532142
http://dx.doi.org/10.1371/journal.pone.0208742
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