title: Implications of augmented renal clearance in critically ill patients.
abstract: Critically ill patients can display markedly abnormal physiological parameters compared with those in ward-based or ambulatory settings. As a function of both the underlying inflammatory state and the interventions provided, these patients manifest substantial changes in their cardiovascular and renal function that are not always immediately discernable using standard diagnostic tests. Impaired renal function is well documented among such individuals; however, even patients with normal serum creatinine concentrations might display elevated glomerular filtration rates, a phenomenon we have termed augmented renal clearance (ARC). This finding has important ramifications for the accurate dosing of renally eliminated drugs, given that most pharmaceutical dosing regimens were validated outside the critical care environment. Empirical approaches to dosing are unlikely to achieve therapeutic drug concentrations in patients with ARC, placing them at risk of suboptimal drug exposure and potential treatment failure. With an increasing appreciation of this phenomenon, alternative dosing strategies will need to be investigated.
authors.affiliation: Burns, Trauma, and Critical Care Research Center, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia. andrew_udy@health.qld.gov.au
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Udy
authors.forename: Jason A
authors.initials: JA
authors.lastname: Roberts
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lipman
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics; D000925:Anticoagulants / Q000493:pharmacokinetics; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000453:epidemiology*; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000502:physiology*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants