Kidney-Brain Link in Traumatic Brain Injury Patients? A preliminary report

Dias, Celeste; Gaio, Rita; Monteiro, Elisabete; Barbosa, Silvina; Cerejo, António; Donnelly, Joseph E.; Felgueiras, Óscar; Smielewski, Peter; Paiva, José Artur; Czosnyka, Marek

doi:10.1007/s12028-014-0045-1

Cited by 37 publications

(29 citation statements)

References 35 publications

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“…The onset of the central nervous system (CNS) changes associated with critical illness is not known. This may be relevant for ARC risks because a relationship between CNS autoregulatory function and GFR was described . In critically ill patients with severe TBI, Cl cr appears to be inversely related to cerebrovascular pressure reactivity .…”

Section: Identifying Patients At Risk For Arcmentioning

confidence: 97%

“…This may be relevant for ARC risks because a relationship between CNS autoregulatory function and GFR was described. 26 In critically ill patients with severe TBI, Cl cr appears to be inversely related to cerebrovascular pressure reactivity. 26 Fluctuations in pituitary hormones including cortisol and suppressed concentrations of vasopressin are well described in critically ill populations.…”

Section: Potential Mechanisms and Arc Risk Factorsmentioning

confidence: 99%

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Augmented Renal Clearance

2019

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Augmented renal clearance (ARC) is a phenomenon in critically ill patients characterized by increased creatinine clearance and elimination of renally eliminated medications. Patients with severe neurologic injury, sepsis, trauma, and burns have been consistently identified as at risk of ARC, with mean creatinine clearances ranging from 170 ml/minute to more than 300 ml/minute. Several potential mechanisms may contribute to the occurrence of ARC including endogenous responses to increased metabolism and solute production, alterations in neurohormonal balance, and therapeutic maneuvers such as fluid resuscitation. Augmented renal clearance is associated with suboptimal exposure to critical medications, including β‐lactams and vancomycin, increasing the risk of treatment failure. Although definitive screening tools are not yet known, critical care pharmacists must be vigilant in recognizing when ARC may be a contributing factor affecting expected treatment outcomes in individual patients. Optimizing dosing strategies in critically ill patients with ARC remains a goal of continued research. The current review discusses the clinical characteristics and methods of identifying patients at risk of ARC, potential mechanisms for ARC, and describes pharmacotherapy dosing considerations in patients with ARC.

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Section: Identifying Patients At Risk For Arcmentioning

confidence: 97%

Section: Potential Mechanisms and Arc Risk Factorsmentioning

confidence: 99%

Augmented Renal Clearance

2019

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“…20 As commented by the authors, the exact mechanisms underpinning this observation remain uncertain, although whether a specific plasma mediator (such as ANP) is implicated, remains an attractive theory.…”

Section: Page 13 Of 28mentioning

confidence: 99%

Augmented Renal Clearance in Traumatic Brain Injury: A Single-Center Observational Study of Atrial Natriuretic Peptide, Cardiac Output, and Creatinine Clearance

Udy

Jarrett

Lassig-Smith

et al. 2017

Journal of Neurotrauma

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Augmented renal clearance (ARC) is being increasingly described in neurocritical care practice. The mechanisms driving this phenomenon are largely unknown. The aim of this project was therefore to explore changes in renal function, cardiac output (CO), and atrial natriuretic peptide (ANP) concentrations in patients with isolated traumatic brain injury (TBI). This prospective observational cohort study was conducted in a tertiary-level, university-affiliated intensive care unit (ICU). Patients with normal plasma creatinine concentrations (<120 μmol/L) at admission and no history of chronic kidney disease, admitted with isolated TBI, were eligible for enrollment. Continuous CO measures were obtained using arterial pulse waveform analysis. Eight-hour urinary creatinine clearances (CL) were used to quantify renal function. ANP concentrations in plasma were measured on alternate days. Data were collected from study enrollment until ICU discharge, death, or day 15, which ever came first. Eleven patients, contributing 100 ICU days of physiological data, were enrolled into the study. Most participants were young men, requiring mechanical ventilation. Median ICU length of stay was 9.6 [7.8-13.0] days. Elevated CL measures (>150 mL/min) were frequent and appeared to parallel changes in CO. Plasma ANP concentrations were also significantly elevated over the study period (minimum value = 243 pg/mL). These data suggest that ARC is likely to complicate the care of TBI patients with normal plasma creatinine concentrations, and may be driven by associated cardiovascular changes and/or elevated plasma ANP concentrations. However, significant additional research is required to further understand these findings.

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“…The first article by Dias et al [3] reports a retrospective small series of 18 TBI patients in which various laboratory values were analyzed, including serum creatinine. The authors estimated both creatinine clearance (CrCL) and GFR using two creatinine-based equations: the Cockroft-Gault and the four-point Modification of Diet in Renal Diseases (MDRD) equations, respectively.…”

mentioning

confidence: 99%