Augmented renal clearance (
ARC) is a manifestation of enhanced renal function seen in
critically ill patients. The use of regular unadjusted doses of renally eliminated drugs in patients with
ARC might lead to
therapy failure. The purpose of this scoping review was to provide and up-to-date summary of the available evidence pertaining to the phenomenon of
ARC. A literature search of databases of available evidence in humans, with no language restriction, was conducted. Databases searched were MEDLINE (1946 to April 2017), EMBASE (1974 to April 2017) and the Cochrane Library (1999 to April 2017). A total of 57 records were included in the present review: 39 observational studies (25 prospective, 14 retrospective), 6 case reports/series and 12 conference abstracts.
ARC has been reported to range from 14-80%.
ARC is currently defined as an increased
creatinine clearance of greater than 130 mL/min/1.73 m² best measured by 8-24 h urine collection. Patients exhibiting
ARC tend to be younger (<50 years old), of male gender, had a recent history of
trauma, and had lower
critical illness severity scores. Numerous studies have reported antimicrobials treatment failures when using standard dosing regimens in patients with
ARC. In conclusion,
ARC is an important phenomenon that might have significant impact on outcome in
critically ill patients. Identifying patients at risk, using higher doses of renally eliminated drugs or use of non-renally eliminated alternatives might need to be considered in ICU patients with
ARC. More research is needed to solidify dosing recommendations of various drugs in patients with
ARC.