[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 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 >1.3 mg/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 >120 mL/min/1.73 m²), 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.
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
María Luz
ML
Campassi
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
María Cecilia
MC
Gonzalez
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Fabio Daniel
FD
Masevicius
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Alejandro Risso
AR
Vazquez
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Miriam
M
Moseinco
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Noelia Cintia
NC
Navarro
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Luciana
L
Previgliano
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Nahuel Paolo
NP
Rubatto
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Martín Hernán
MH
Benites
Serviço de Terapia Intensiva, Hospital General de Agudos "General San Martín", La Plata, Argentina.
Elisa
E
Estenssoro
Serviço de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina.
Arnaldo
A
Dubin
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood* / Q000652:urine; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics*
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D003404:Creatinine