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Dosing renally cleared drugs in critically ill children: mind the trap of glomerular hyperfiltration!

Pieter De Cock UGent, Tatjana Van Der Heggen UGent, Evelyn Dhont UGent, Nicky Boeykens, Karlien Roelandt, Benjamin Leenknegt, Harlinde Peperstraete, Joris Delanghe UGent, Johan Vande Walle UGent and Peter De Paepe UGent (2018) In Belgian Journal of Hospital Pharmacy (BJHP) 1.
abstract
INTRODUCTION Glomerular hyperfiltration (GHF), defined as an elevated glomerular filtration rate (GFR), induces the enhanced elimination of circulating solute by the kidneys. Recently, this phenomenon has received increasing attention in critically ill adults. The incidence in this setting is high, varying between 28-65%. In case of treatment with renally eliminated drugs, GHF suggests that these patients may be at risk for subtherapeutic drug concentrations when using standard dosage schedules. To date, data on the incidence of GHF in critically ill children are scarce. AIM The primary objective of this study was to investigate the incidence of GHF in critically ill children. Secondly, risk factors for the development of GHF were identified. METHODS This study was a single center, prospective, observational study, conducted at the Ghent University Hospital, Belgium, enrolling patients between 1 month and 15 years of age. GFR was measured by means of a calculated 24 hours creatinine clearance (24h ClCr). Creatinine in serum and urine were determined using Jaffe's reaction. GHF was defined as a GFR exceeding normal values for age plus two standard deviations. Logistic regression analysis was used to identify covariates for GHF. RESULTS Data were collected from 65 patients (median age 1.7 years, IQR 3.0). Overall, 84.6% of patients expressed GHF. The incidence slowly decreased during consecutive days after admission to the ICU. GHF patients had a median ClCr of 181.8 ml/min/1.73m² (IQR 78.9). Younger age and the absence of vasopressor support were found as independently associated factors with the development of hyperfiltration. CONCLUSIONS The incidence of GHF in critically ill children seems even higher compared to adults, using an age dependent definition. As GHF may lead to subtherapeutic treatment of renally eliminated drugs, early detection of patients at risk should be of main importance.
Please use this url to cite or link to this publication:
author
organization
year
type
conference (poster)
publication status
published
subject
series title
Belgian Journal of Hospital Pharmacy (BJHP)
volume
1
pages
3 -
conference name
Dag van de ziekenhuisapotheker 2018
conference start
2018-02-06
language
English
UGent publication?
yes
classification
U
copyright statement
I have retained and own the full copyright for this publication
id
8564526
handle
http://hdl.handle.net/1854/LU-8564526
alternative location
https://www.bjhp.be/sites/default/files/bjhp_2018_1_abstracts_dvza.pdf
date created
2018-06-07 11:56:07
date last changed
2018-06-08 13:57:37
@inproceedings{8564526,
  abstract     = {INTRODUCTION
Glomerular hyperfiltration (GHF), defined as an elevated glomerular filtration rate (GFR), induces the enhanced
elimination of circulating solute by the kidneys. Recently, this phenomenon has received increasing attention in critically ill adults. The incidence in this setting is high, varying between 28-65\%. In case of treatment with renally eliminated drugs, GHF suggests that these patients may be at risk for subtherapeutic drug concentrations when using standard dosage schedules. To date, data on the incidence of GHF in critically ill children are scarce.

AIM
The primary objective of this study was to investigate the incidence of GHF in critically ill children. Secondly, risk factors
for the development of GHF were identified. 

METHODS
This study was a single center, prospective, observational study, conducted at the Ghent University Hospital, Belgium, enrolling patients between 1 month and 15 years of age. GFR was measured by means of a calculated 24 hours creatinine clearance (24h ClCr). Creatinine in serum and urine were determined using Jaffe's reaction. GHF was defined as a GFR exceeding normal values for age plus two standard deviations. Logistic regression analysis was used to identify covariates for GHF.

RESULTS
Data were collected from 65 patients (median age 1.7 years, IQR 3.0). Overall, 84.6\% of patients expressed GHF. The incidence slowly decreased during consecutive days after admission to the ICU. GHF patients had a median ClCr of 181.8 ml/min/1.73m{\texttwosuperior} (IQR 78.9). Younger age and the absence of vasopressor support were found as independently associated factors with the development of hyperfiltration.

CONCLUSIONS
The incidence of GHF in critically ill children seems even higher compared to adults, using an age dependent definition. As GHF may lead to subtherapeutic treatment of renally eliminated drugs, early detection of patients at risk should be of main importance.
},
  author       = {De Cock, Pieter and Van Der Heggen, Tatjana and Dhont, Evelyn and Boeykens, Nicky and Roelandt, Karlien and Leenknegt, Benjamin and Peperstraete, Harlinde and Delanghe, Joris and Vande Walle, Johan and De Paepe, Peter},
  language     = {eng},
  title        = {Dosing renally cleared drugs in critically ill children: mind the trap of glomerular hyperfiltration! },
  url          = {https://www.bjhp.be/sites/default/files/bjhp\_2018\_1\_abstracts\_dvza.pdf},
  volume       = {1},
  year         = {2018},
}

Chicago
De Cock, Pieter, Tatjana Van Der Heggen, Evelyn Dhont, Nicky Boeykens, Karlien Roelandt, Benjamin Leenknegt, Harlinde Peperstraete, Joris Delanghe, Johan Vande Walle, and Peter De Paepe. 2018. “Dosing Renally Cleared Drugs in Critically Ill Children: Mind the Trap of Glomerular Hyperfiltration! .” In , 1:3.
APA
De Cock, P., Van Der Heggen, T., Dhont, E., Boeykens, N., Roelandt, K., Leenknegt, B., Peperstraete, H., et al. (2018). Dosing renally cleared drugs in critically ill children: mind the trap of glomerular hyperfiltration! (Vol. 1, p. 3). Presented at the Dag van de ziekenhuisapotheker 2018.
Vancouver
1.
De Cock P, Van Der Heggen T, Dhont E, Boeykens N, Roelandt K, Leenknegt B, et al. Dosing renally cleared drugs in critically ill children: mind the trap of glomerular hyperfiltration! . 2018. p. 3.
MLA
De Cock, Pieter, Tatjana Van Der Heggen, Evelyn Dhont, et al. “Dosing Renally Cleared Drugs in Critically Ill Children: Mind the Trap of Glomerular Hyperfiltration! .” Vol. 1. 2018. 3. Print.