Outcomes in patients with infections and augmented renal clearance: A multicenter retrospective study

Abstract

Recently, augmented renal clearance (ARC), which accelerates glomerular filtration of renally eliminated drugs thereby reducing the systemic exposure to these drugs, has started to receive attention. However, the clinical features associated with ARC are still not well understood, especially in the Japanese population. This study aimed to evaluate the clinical characteristics and outcomes of ARC patients with infections in Japanese intensive care unit (ICU) settings. We conducted a retrospective observational study from April 2013 to May 2017 at two tertiary level ICUs in Japan, which included 280 patients with infections (median age 74 years; interquartile range, 64–83 years). We evaluated the estimated glomerular filtration rate (eGFR) at ICU admission using the Japanese equation, and ARC was defined as eGFR >130 mL/min/1.73 m2. Multivariable logistic regression analysis was performed to identify the independent risk factors for ARC and to determine if it was a predictor of ICU mortality. In addition, a receiver operating curve (ROC) analysis was performed, and the area under the ROC (AUROC) was determined to examine the significant variables that predict ARC. In total, 19 patients (6.8%) manifested ARC. Multivariable logistic regression analysis identified younger age as an independent risk factor for ARC (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.91–0.96). However, ARC was not found to be a predictor of ICU mortality (OR, 0.57; 95% CI, 0.11–2.92). In addition, the AUROC of age was 0.79 (95% CI, 0.68–0.91), and the optimal cut off age for ARC was ≤63 years (sensitivity, 68.4%; specificity, 78.9%). The incidence of ARC was, therefore, low among patients with infections in the Japanese ICUs. Although younger age was associated with the incidence of ARC, it was not an independent predictor of ICU mortality.

An individualized administration model of vancomycin in elderly patients with sepsis and factors influencing augmented renal clearance

“…The patients with ARC in the present study accounted for 14.9% of the sample, and a higher BMI and lower serum creatinine level were independent predictors of ARC. Recently, Kawano et al 28 reported that the incidence of ARC was only 6.8% in 280 Japanese patients in the ICU, which was much lower than that found in other studies. However, that study involved many elderly patients, with a median age of 74 years, and the oldest patient was 106 years old.…”

“…The relatively few young patients in that study could, therefore, account for the lower prevalence of ARC. The study by Kawano et al 28 also used estimated glomerular filtration‐rate values that were calculated by a Japanese equation for evaluating ARC and that equation was reported to underestimate the glomerular filtration rate in ICU settings. The use of different assessment techniques, such as various equations for diagnosing ARC, might have yielded different results for the incidence of ARC.…”

Pharmacists’ Knowledge About the Impact of Augmented Renal Clearance on Antimicrobial Dosing in Critically Ill Patients: A Cross-Sectional Study

“…A threshold CrCl of ≥ 170 ml/min was associated with beta-lactam antibiotic underdosing and more therapeutic failures [ 18 ]. Contrarily, other studies did not find an association between ARC-induced beta-lactam antibiotics renal elimination enhancement and mortality, which could be explained by the low prevalence of ARC in the population studied and the use of combination therapy, which could obscure the effect of ARC on clinical outcomes [ 13 , 16 , 29 , 30 ].…”

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

“…In the analysis cohort, ARC did not affect mortality (Table 4). Previous studies have also reported that ARC reduces the internal concentration of antibiotics but does not exacerbate overall mortality 5,6,25,26 . This observation may be related to the fact that ARC is more likely to occur in patients with less severe conditions 6 .…”

“…ARC is commonly observed in 14%–80% of the patients in intensive care units (ICU) 1 . Certain risk factors for ARC in ICU patients, for example, young age (<50 years), male sex, trauma and traumatic brain injury, have been identified 1,3‐6 …”