HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

[Augmented renal clearance in critically ill patients: incidence, associated factors and effects on vancomycin treatment].

AbstractOBJECTIVE:
An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the effects on vancomycin concentrations and dosing in a series of intensive care unit patients.
METHODS:
We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3 mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120 mL/min/1.73 m²), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered.
RESULTS:
Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p<0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations.
CONCLUSIONS:
In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
AuthorsMaría Luz Campassi, María Cecilia Gonzalez, Fabio Daniel Masevicius, Alejandro Risso Vazquez, Miriam Moseinco, Noelia Cintia Navarro, Luciana Previgliano, Nahuel Paolo Rubatto, Martín Hernán Benites, Elisa Estenssoro, Arnaldo Dubin
JournalRevista Brasileira de terapia intensiva (Rev Bras Ter Intensiva) 2014 Jan-Mar Vol. 26 Issue 1 Pg. 13-20 ISSN: 1982-4335 [Electronic] Brazil
Vernacular TitleIncremento da depuração renal em pacientes gravemente enfermos: incidência, fatores associados e efeitos no tratamento com vancomicina.
PMID24770684 (Publication Type: English Abstract, Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Vancomycin
  • Creatinine
Topics
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents (administration & dosage, pharmacokinetics)
  • Cohort Studies
  • Creatinine (blood, urine)
  • Critical Illness
  • Dose-Response Relationship, Drug
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Intensive Care Units
  • Kidney Function Tests
  • Logistic Models
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Vancomycin (administration & dosage, pharmacokinetics)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: