Augmented renal clearance in critically ill trauma patients: A pathophysiologic approach using renal vascular index

Carrié, C.; Lannou, Alexandre; Rubin, Sébastien; Courson, Hugues de; Petit, Laurent; Biais, Matthieu

doi:10.1016/j.accpm.2018.12.004

Cited by 13 publications

(14 citation statements)

References 26 publications

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“…-Moreover, perturbations in renal hemodynamics may lead to an enhanced glomerular filtration rate which may be considered as a contributing factor for the enhanced tubular fluid output [13]. Our results are in accordance with a previous report suggesting a significant relationship between 24-CL CR and urinary osmole excretion over the first days after TBI [14]. The hypothesis underlying these results was that the marked increase in GFR should be associated with an increased tubular fluid output, responsible for an enhanced diuresis and osmole excretion.…”

Section: Discussionsupporting

confidence: 92%

Salt wasting syndrome in brain trauma patients: a pathophysiologic approach using sodium balance and urinary biochemical analysis

Lannou

Carrié

Rubin³

et al. 2020

BMC Neurol

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Background: To explore the underlying mechanisms leading to the occurrence of hyponatremia and enhanced urinary sodium excretion in brain trauma patients using sodium balance and urinary biochemical analysis. Methods: We conducted a retrospective analysis of a local database prospectively collected in 60 brain trauma patients without chronic renal dysfunction. Metabolic and hemodynamic parameters were averaged over three consecutive periods over the first seven days after admission. The main outcome investigated in this study was the occurrence of at least one episode of hyponatremia. Results: Over the study period, there was a prompt decrease in sodium balance (163 ± 193 vs.-12 ± 154 mmol/day, p < 0.0001) and free water clearance (− 0.7 ± 0.7 vs.-1.8 ± 2.3 ml/min, p < 0.0001). The area under the ROC curves for sodium balance in predicting the occurrence of hyponatremia during the next period was 0.81 [95% CI: 0.64-0.97]. Variables associated with averaged urinary sodium excretion were sodium intake (R 2 = 0.26, p < 0.0001) and fractional excretion of urate (R 2 = 0.15, p = 0.009). Urinary sodium excretion was also higher in patients with sustained augmented renal clearance over the study period (318 ± 106 vs. 255 ± 135 mmol/day, p = 0.034). Conclusion: The decreased vascular volume resulting from a negative sodium balance is a major precipitating factor of hyponatremia in brain trauma patients. Predisposing factors for enhanced urinary sodium excretion were high sodium intake, high fractional excretion of urate and augmented renal clearance over the first seven days after ICU admission.

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Section: Discussionsupporting

confidence: 92%

Salt wasting syndrome in brain trauma patients: a pathophysiologic approach using sodium balance and urinary biochemical analysis

Lannou

Carrié

Rubin³

et al. 2020

BMC Neurol

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“…However, commonly used formulas frequently misclassify ARC and may underestimate the risk of β-lactam underdosing [27, 28]. Although several screening tools have shown adequate predictive abilities for identifying patients with ARC, 24-h measured CL CR must remain the reference and should be monitored daily in at-risk patients [29, 30]. On the other hand, dose adaptations solely based on CL CR are probably not sufficient to achieve target therapeutic concentrations [31].…”

Section: Discussionmentioning

confidence: 99%

Increased β-Lactams dosing regimens improve clinical outcome in critically ill patients with augmented renal clearance treated for a first episode of hospital or ventilator-acquired pneumonia: a before and after study

et al. 2019

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BackgroundAugmented renal clearance (ARC) is recognized as a leading cause of β-lactam subexposure when conventional dosing regimens are used. The main objective was to compare the clinical outcome of ARC patients treated by conventional or increased β-lactam dosing regimens for a first episode of hospital or ventilator-acquired pneumonia (HAP-VAP).MethodsIn this single-center, retrospective study, every ARC patient treated by β-lactam for a first episode of HAP-VAP was included during two 15-month periods, before (Control period) and after (Treatment period) the modification of a local antibiotic therapy protocol. ARC was defined by a 24-h measured creatinine clearance ≥ 150 ml/min. The primary endpoint was defined as a therapeutic failure of the antimicrobial therapy or a HAP-VAP relapse within 28 days. Inverse probability of treatment weight (IPTW) was derived from a propensity score model. Cox proportional hazard models were used to evaluate the association between treatment period and clinical outcome.ResultsDuring the study period, 177 patients were included (control period, N = 88; treatment period, N = 89). Therapeutic failure or HAP-VAP relapse was significantly lower in the treatment period (10 vs. 23%, p = 0.019). The IPTW-adjusted hazard ratio of poor clinical outcome in the treatment period was 0.35 (95% CI 0.15–0.81), p = 0.014. No antibiotic side effect was reported during the treatment period.ConclusionsHigher than licensed dosing regimens of β-lactams may be safe and effective in reducing the rate of therapeutic failure and HAP-VAP recurrence in critically ill augmented renal clearance (ARC) patients.

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“…However, these reports suggest that the presence or absence of ARC does not change patient outcomes. Carrié et al reported that in cases of severe pneumonia, administration of higher doses of beta‐lactam antibiotics to patients with ARC resulted in significantly lower treatment failure rates and comparable safety 21 . Thus, there is no consensus on the effect of ARC on patient outcomes, and we must continually verify this matter.…”

Section: Discussionmentioning

confidence: 98%

“…Through multivariate analysis, we identified young age, leukaemia and low SCr as independent risk factors for ARC. Although the pathology of ARC is not entirely clear, it is suggested to be caused by increased renal blood flow secondary to increased cardiac output and peripheral vasodilatation 1,3,21 . Generally, young people are at risk of ARC because of their higher residual kidney function.…”

Section: Discussionmentioning

confidence: 99%

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A simple scoring method to predict augmented renal clearance in haematologic malignancies

et al. 2020

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What is known and objective Augmented renal clearance (ARC; hyperfiltration with over 130 mL/min/1.73 m2 of creatinine clearance (CLcr)) commonly occurs in critically ill patients. Recent reports indicate that ARC also occurs in haematologic malignancies. However, the risk factors for ARC in haematologic malignancies remain unknown, and there is no established method to predict ARC in haematologic malignancies. Our objective was to explore the risk factors for ARC retrospectively and develop a scoring method to predict ARC. Methods A single‐centre, retrospective, observational cohort study was conducted at the Sendai Medical Center (Sendai, Japan); 133 patients (April 2017‐March 2019) and 41 patients (April‐November 2019) with haematopoietic tumours who were administered vancomycin were enrolled in the analysis and validation cohorts, respectively. To define ARC, we calculated the vancomycin serum concentration when CLcr = 130 mL/min/1.73 m2 using a one‐compartment model. Patients with ARC were defined as those whose actual concentration of vancomycin remained lower than the calculated concentration. Using the analysis cohort, we explored risk factors of ARC and developed a scoring method to predict ARC in haematologic malignancies. The reproducibility of the scoring system was demonstrated using the validation cohort. Results and discussion Through multivariate analysis, young age (P < .001), leukaemia (P = .001) and low serum creatinine (P < .001) were identified as risk factors. According to this result, we established the ARC detection method: age ≤ 50 years = 3 points, 50 years < age ≤65 years = 1 point, leukaemia = 2 points, low SCr = 2 points; patients scoring ≥ 5 points represent the ARC high‐risk group. Using this scoring system, we could detect ARC with a sensitivity and specificity of 60.0% and 89.7% in the analysis cohort and 90.0% and 90.9% in the validation cohort, respectively. What is new and conclusion Our scoring method could predict ARC in haematologic malignancies and is useful as a simple screening tool for ARC.

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Augmented renal clearance in critically ill trauma patients: A pathophysiologic approach using renal vascular index

Cited by 13 publications

References 26 publications

Salt wasting syndrome in brain trauma patients: a pathophysiologic approach using sodium balance and urinary biochemical analysis

Salt wasting syndrome in brain trauma patients: a pathophysiologic approach using sodium balance and urinary biochemical analysis

Increased β-Lactams dosing regimens improve clinical outcome in critically ill patients with augmented renal clearance treated for a first episode of hospital or ventilator-acquired pneumonia: a before and after study

A simple scoring method to predict augmented renal clearance in haematologic malignancies

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