P25 Comparison of renal function estimation methods in critically ill children: a pilot study

Dhont, Evelyn; Heggen, Tatjana Van Der; Jaeger, Annik de; Willems, Jef; Baere, Siegrid De; Croubels, Siska; Walle, Johan Vande; Paepe, Peter De; Cock, Pieter De

doi:10.1136/archdischild-2019-esdppp.63

Cited by 2 publications

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“…Review of titles and abstracts led to the retrieval of 215 potentially relevant full‐text citations. After full‐text review, 25 citations met the criteria for inclusion 16–41 . The most common reason for exclusion was non‐pediatric population studies (190 citations), followed by lack of ARC data (24 citations).…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes the characteristics of the studies included based upon their primary objective 16–41 . The first articles related to ARC in pediatrics were published in 2015 and were pharmacokinetic objective studies 20,36 .…”

Section: Resultsmentioning

confidence: 99%

“…The first articles related to ARC in pediatrics were published in 2015 and were pharmacokinetic objective studies 20,36 . In 2019, the first articles were published that evaluated general information related to ARC in pediatric patients 16,28,34 . Most of the published work (84%) has described the impact of ARC on pharmacokinetic/pharmacodynamic alterations in antimicrobial agents 18–22,24–27,29–33,35–41 .…”

Section: Resultsmentioning

confidence: 99%

“…Another plausible explanation for the wide range of prevalence is related to the inconsistent methodology used to estimate or measure renal function to detect the presence of ARC. Dhont et al 28 was the only study that utilized iohexol, which is considered a gold standard for measuring GFR, and reported a prevalence of 50% based upon an ARC definition of GFR exceeding an upper limit of normal values for age plus two standard deviations. The most common approach in clinical practice for GFR determination is using measured urinary CrCl or serum creatinine in specific equations for estimating GFR like the modified Schwartz formula, which was utilized in 64% of the included studies 46 .…”

Section: Discussionmentioning

confidence: 99%

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Scoping review of augmented renal clearance in critically ill pediatric patients

2021

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Augmented renal clearance (ARC), a phenomenon of enhanced elimination of renal solutes, has been described in adult critically ill patients, but little is known about the phenomenon in children. The aim of this scoping review was to gather and summarize all evidence on ARC in pediatric patients to examine its breadth and depth including prevalence, risk factors, and pharmacokinetic alterations and identify any gaps for further areas of inquiry. PubMed, Embase, and Web of Science were searched for titles, abstracts, or keywords that focused on ARC. Non‐English studies, reviews, and nonhuman studies were excluded. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews (PRISMA‐ScR) guidelines. Data were extracted on article type, study details, patient population, ARC definition and prevalence, methods of renal function assessment, and study results. A total of 215 citations were found with 25 citations meeting the criteria for inclusion in pediatrics (2102 total patients); the majority of studies (84%) focused on pharmacokinetics (PK) of antimicrobial agents. The median/mean age range was 1.25–12 years. There were a total of 10 different definitions of ARC. The prevalence of ARC ranged from 7.8% to 78%. The most common method for documenting creatinine clearance (CrCl) was the modified Schwartz equation (64%). Only 20% of studies reported risk factors for ARC including low serum creatinine, increasing age, febrile neutropenia, male, septic shock, and treatment with antibiotics. Glycopeptide antimicrobials were the most evaluated class (42.9%) among the 21 antimicrobial drug studies. All studies reported increased drug clearance and/or poor probability of achieving target concentrations of the agents studied. ARC showed variable prevalence in pediatric patients likely due to the lack of a standard definition and many studies not considering age‐related changes in CrCl with pediatric intensive care unit (PICU) patients. ARC was shown to impact PK of antibiotics commonly administered to pediatric patients, which may necessitate changes in standard dosing regimens.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Scoping review of augmented renal clearance in critically ill pediatric patients

2021

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“…The limitations of our study include the small number of patients, the lack of follow-up to evaluate the microbiology and the clinical outcome. Additionally, according to Dhont et al, ( 22 ) the Schwartz formula may underestimate renal function. However, the calculations of renal clearance of the drug, its half-life and the AUC ss 0-24 were based on the decrease in the serum level of the drug and the time required for it to occur and were not influenced by serum creatinine levels.…”

Section: Discussionmentioning

confidence: 99%

Does vancomycin administered at an empirical dose ensure coverage of pediatric patients against grampositive pathogens?

Pires¹,

Paula²,

Delgado³

et al. 2020

Revista Brasileira De Terapia Intensiva

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Objective To investigate the vancomycin effectiveness against gram-positive pathogens with the minimum inhibitory concentration of 1mg/L in pediatric patients based on the area under the curve and the minimum inhibitory concentration ratio > 400. Methods A population of 22 pediatric patients (13 boys) admitted to the pediatric intensive care unit with preserved renal function was stratified in two groups (G1 < 7 years and G2 ≥ 7 years). After the fourth dose administered of vancomycin (10 - 15mg/kg every 6 hours) was administered, two blood samples were collected (third and fifth hours), followed by serum measurement by immunoassays to investigate the pharmacokinetics and antimicrobial coverage. Results There was no difference between the groups regarding dose, trough level or area under the curve. Coverage against gram-positive pathogens with a minimum inhibitory concentration of 1mg/L occurred in only 46% of patients in both groups. The pharmacokinetics in both groups were altered relative to the reference values, and the groups differed in regard to increased total body clearance and shortening of the biological half-life, which were more pronounced in younger patients. Conclusion A minimum empirical dose of 60mg/kg per day should be prescribed for pediatric patients in intensive care units with preserved renal function. The use of the ratio between the area under the curve and minimum inhibitory concentration in the evaluation of vancomycin coverage is recommended to achieve the desired outcome, since the pharmacokinetics are altered in these patients, which may impact the effectiveness of the antimicrobial.

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P25 Comparison of renal function estimation methods in critically ill children: a pilot study

Cited by 2 publications

References 0 publications

Scoping review of augmented renal clearance in critically ill pediatric patients

Scoping review of augmented renal clearance in critically ill pediatric patients

Does vancomycin administered at an empirical dose ensure coverage of pediatric patients against grampositive pathogens?

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