Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?

被引:0
作者
Evelyn Dhont
Tatjana Van Der Heggen
Annick De Jaeger
Johan Vande Walle
Peter De Paepe
Pieter A. De Cock
机构
[1] Ghent University Hospital,Department of Pediatric Intensive Care
[2] Ghent University Hospital,Pediatric Intensive Care 1K12D
[3] Ghent University Hospital,Department of Pediatrics
[4] Ghent University Hospital,Department of Pediatric Nephrology
[5] Ghent University,Heymans Institute of Pharmacology
[6] Ghent University Hospital,Department of Pharmacy
来源
Pediatric Nephrology | 2020年 / 35卷
关键词
Children; Critical illness; Intensive care; Glomerular filtration rate; Augmented renal clearance; Renal drug clearance;
D O I
暂无
中图分类号
学科分类号
摘要
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to assess renal function in critically ill children. Standard equations to calculate glomerular filtration rate (GFR) are developed for patients who have a steady-state creatinine production and a stable renal function. Those formulas are not reliable in critically ill patients with acutely changing GFR and tend to underestimate true GFR in patients with ARC. Tools for real-time, continuous, and non-invasive measurement of fluctuating GFR are most needed to identify changes in kidney function during critical illness and therapeutic interventions. Such devices are currently being validated and hold a strong potential to become the standard of practice. In the meantime, urinary creatinine clearance is considered the most reliable method to detect ARC in critically ill patients. Augmented renal clearance is clearly associated with subtherapeutic antimicrobial concentrations and subsequent therapeutic failure. This warrants the need for adjusted dosing regimens to optimize pharmacokinetic and pharmacodynamic target attainment. This review aims to summarize current knowledge on ARC in critically ill children, to give insight into its possible pathophysiological mechanism, to evaluate screening methods for ARC in the pediatric intensive care population, and to illustrate the effect of ARC on drug exposure, therapeutic efficacy, and clinical outcome.
引用
收藏
页码:25 / 39
页数:14
相关论文
共 809 条
  • [1] Kearns GL(2003)Developmental pharmacology--drug disposition, action, and therapy in infants and children N Engl J Med 349 1157-1167
  • [2] Abdel-Rahman SM(2017)Clinical pharmacology studies in critically ill children Pharm Res 34 7-24
  • [3] Alander SW(2006)Pharmacokinetic changes in critical illness Crit Care Clin 22 vi-680
  • [4] Blowey DL(2008)Glomerular hyperfiltration and albuminuria in critically ill patients Anaesth Intensive Care 36 674-527
  • [5] Leeder JS(2011)Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study Crit Care 15 R49-1121
  • [6] Kauffman RE(2014)Augmented renal clearance in the ICU: results of a multicenter observational study of renal function in critically ill patients with normal plasma creatinine concentrations* Crit Care Med 42 520-449
  • [7] Thakkar N(2018)Augmented renal clearance in critically ill patients: a systematic review Clin Pharmacokinet 57 1107-700
  • [8] Salerno S(2015)Are standard doses of piperacillin sufficient for critically ill patients with augmented creatinine clearance? Crit Care 19 28-396
  • [9] Hornik CP(2013)Meropenem and piperacillin/tazobactam prescribing in critically ill patients: does augmented renal clearance affect pharmacokinetic/pharmacodynamic target attainment when extended infusions are used? Crit Care 17 R84-608
  • [10] Gonzalez D(2017)Association between augmented renal clearance, antibiotic exposure and clinical outcome in critically ill septic patients receiving high doses of beta-lactams administered by continuous infusion. A prospective observational study Int J Antimicrob Agents 51 443-20