title: Augmented renal clearance is a common finding with worse clinical outcome in critically ill patients receiving antimicrobial therapy.
abstract: BACKGROUND
  We describe incidence and patient factors associated with augmented renal clearance (ARC) in adult intensive care unit (ICU) patients.
  
  
  METHODS
  A prospective observational study in a mixed cohort of surgical and medical ICU patients receiving antimicrobial therapy at the Ghent University Hospital, Belgium. Kidney function was assessed by the 24-hour creatinine clearance (Ccr); ARC defined as at least one Ccr of >130 mL/min per 1.73 m2. Multivariate logistic regression analysis: to assess variables associated with ARC occurrence. Therapeutic failure (TF): an impaired clinical response and need for alternate antimicrobial therapy.
  
  
  RESULTS
  Of the 128 patients and 599 studied treatment days, ARC was present in 51.6% of the patients. Twelve percent permanently expressed ARC. ARC patients had a median Ccr of 144 mL/min per 1.73 m2 (IQR 98-196). Median serum creatinine concentration on the first day of ARC was 0.54 mg/dL (IQR 0.48-0.69). Patients with ARC were significantly younger (P<.001). Age and male gender were independently associated with ARC whereas the APACHE II score was not. ARC patients had more TF (18 (27.3%) vs. 8 (12.9%); P=.04).
  
  
  CONCLUSIONS
  ARC was documented in approximately 52% of a mixed ICU patient population receiving antibiotic treatment with worse clinical outcome. Young age and male gender were independently associated with ARC presence.
authors.affiliation: Pharmacy Department, Ghent University Hospital, Pharmacy, 9000 Ghent, Belgium. Electronic address: Barbara.Claus@UZGENT.be.
authors.forename: Barbara O M
authors.initials: BO
authors.lastname: Claus
authors.forename: Eric A
authors.initials: EA
authors.lastname: Hoste
authors.forename: Kirsten
authors.initials: K
authors.lastname: Colpaert
authors.forename: Hugo
authors.initials: H
authors.lastname: Robays
authors.forename: Johan
authors.initials: J
authors.lastname: Decruyenaere
authors.forename: Jan J
authors.initials: JJ
authors.lastname: De Waele
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001530:Belgium / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D016638:Critical Illness; D005260:Female; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents; D003404:Creatinine
keywords: 24-hour creatinine clearance; APACHE II; ARC; Acute Physiology and Chronic Health Evaluation II; Antibiotic underdosing; Augmented renal clearance; BSA; Body surface area; CI; CKD-EPI; Ccr; Chronic Kidney Disease Epidemiology Collaboration; Continuous infusion; Creatinine clearance; EI; Extended infusion; GFR; Glomerular filtration rate; Glomerular hyperfiltration; IQR; Interquartile range; LOS; Length of stay; MDRD; MICU; Medical Intensive Care Unit; Modifying Diet in Renal Disease; PDMS; Patient Data Management System; SICU; Scr; Serum creatinine concentration; Surgical Intensive Care Unit; U(cr); U(vol); Urinary creatinine concentration; Urinary volume