title: Augmented Renal Clearance in Patients with Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Patients with subarachnoid hemorrhage (SAH) typically exhibit hyperdynamic cardiovascular hemodynamics, which may lead to increased medication clearance. The aims of this study were to evaluate the actual creatinine clearance (CrClA) in an aneurysmal SAH population and the effect of the development of cerebral vasospasm (CV) along with its treatment to better understand if this population exhibits augmented renal clearance (ARC).
  
  
  METHODS
  This was a prospective, single-center study in a neurosciences ICU at a university hospital. A total of 20 patients were consented and provided a 24-h urine sample to measure the CrClA. If patients experienced CV, a 24-h urine collection was repeated during vasospasm treatment. CrClA was measured using a modified Jaffe assay.
  
  
  RESULTS
  Among the 20 patients enrolled, the mean SAH CrClA was 325.93 ± 135.20 ml/min 1.73 m(2) and this differed significantly from the SAH estimated creatinine clearance (CrClE) 144.93 ± 42.82 ml/min 1.73 m(2) (p < 0.001). Four patients developed CV; the mean CV CrClA was 558.43 ± 356.12 ml/min 1.73 m(2) and there was no significant difference when compared to those patients' mean SAH CrClA (246.91 ± 84.14 ml/min 1.73 m(2), p = 0.16).
  
  
  CONCLUSIONS
  ARC was present in 100 % of the patients with recent SAH enrolled. Although ARC remained present in the patients who experienced CV, their creatinine clearance was not significantly further augmented. Further work is needed to clarify the impact of such clearances on renally excreted medications and how the development and treatment of CV further augment these findings.
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street Room H110, Lexington, KY, 40536, USA.
authors.forename: Casey C
authors.initials: CC
authors.lastname: May
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street Room H110, Lexington, KY, 40536, USA.
authors.forename: Shaily
authors.initials: S
authors.lastname: Arora
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street Room H110, Lexington, KY, 40536, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Parli
authors.affiliation: Department of Neurological Surgery, University of Kentucky HealthCare, 800 Rose Street MS108A, Lexington, KY, 40536, USA.
authors.forename: Justin F
authors.initials: JF
authors.lastname: Fraser
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street Room H110, Lexington, KY, 40536, USA.
authors.forename: Melissa Thompson
authors.initials: MT
authors.lastname: Bastin
authors.affiliation: Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street Room H110, Lexington, KY, 40536, USA. amcook0@email.uky.edu.|Department of Pharmacy Practice & Science, University of Kentucky College of Pharmacy, 798 South Limestone Street, Lexington, KY, 40536, USA. amcook0@email.uky.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Cook
mesh_terms: D000328:Adult; D003404:Creatinine / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065667:Renal Elimination / Q000502:physiology*; D013345:Subarachnoid Hemorrhage / Q000652:urine*; D020301:Vasospasm, Intracranial / Q000652:urine*
chemical_list: D003404:Creatinine
keywords: Aneurysmal subarachnoid hemorrhage; Augmented renal clearance; Creatinine clearance; Stroke; Vasospasm