title: Augmented renal clearance in Japanese intensive care unit patients: a prospective study.
abstract: BACKGROUND
  Augmented renal clearance (ARC) of circulating solutes and drugs has been recently often reported in intensive care unit (ICU) patients. However, only few studies on ARC have been reported in Japan. The aims of this pilot study were to determine the prevalence and risk factors for ARC in Japanese ICU patients with normal serum creatinine levels and to evaluate the association between ARC and estimated glomerular filtration rate (eGFR) calculated using the Japanese equation.
  
  
  METHODS
  We conducted a prospective observational study from May 2015 to April 2016 at the emergency ICU of a tertiary university hospital; 111 patients were enrolled (mean age, 67 years; interquartile range, 53-77 years). We measured 8-h creatinine clearance (CLCR) within 24 h after admission, and ARC was defined as body surface area-adjusted CLCR≥ 130 mL/min/1.73 m2. Multiple logistic regression analysis was performed to identify the risk factors for ARC. Moreover, a receiver operating curve (ROC) analysis, including area under the receiver operating curve (AUROC) was performed to examine eGFR accuracy and other significant variables in predicting ARC.
  
  
  RESULTS
  In total, 43 patients (38.7 %) manifested ARC. Multiple logistic regression analysis was performed for age, body weight, body height, history of diabetes mellitus, Acute Physiology and Chronic Health Evaluation II scores, admission categories of post-operative patients without sepsis and trauma, and serum albumin, and only age was identified as an independent risk factor for ARC (odds ratio, 0.95; 95 % confidence interval [CI], 0.91-0.98). Moreover, the AUROC of ARC for age and eGFR was 0.81 (95 % CI, 0.72-0.89) and 0.81 (95 % CI, 0.73-0.89), respectively. The optimal cutoff values for detecting ARC were age and eGFR of ≤63 years (sensitivity, 72.1 %; specificity, 82.4 %) and ≥76 mL/min/1.73 m2(sensitivity, 81.4 %; specificity, 72.1 %), respectively.
  
  
  CONCLUSIONS
  ARC is common in Japanese ICU patients, and age was an independent risk factor for ARC. In addition, age and eGFR calculated using the Japanese equation were suggested to be useful screening tools for identifying Japanese patients with ARC.
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Kawano
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Izutani
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Muranishi
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Hironari
authors.initials: H
authors.lastname: Kaneyama
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 8140180 Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikura
keywords: Augmented renal clearance; Intensive care unit; Japan; Risk factor; eGFR