Advanced search
1 file | 754.24 KB Add to list

Augmented renal clearance in pediatric intensive care : are we undertreating our sickest patients?

Evelyn Dhont (UGent) , Tatjana Van Der Heggen (UGent) , Annik de Jaeger (UGent) , Johan Vande Walle (UGent) , Peter De Paepe (UGent) and Pieter De Cock (UGent)
(2020) PEDIATRIC NEPHROLOGY. 35(1). p.25-29
Author
Organization
Abstract
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to assess renal function in critically ill children. Standard equations to calculate glomerular filtration rate (GFR) are developed for patients who have a steady-state creatinine production and a stable renal function. Those formulas are not reliable in critically ill patients with acutely changing GFR and tend to underestimate true GFR in patients with ARC. Tools for real-time, continuous, and non-invasive measurement of fluctuating GFR are most needed to identify changes in kidney function during critical illness and therapeutic interventions. Such devices are currently being validated and hold a strong potential to become the standard of practice. In the meantime, urinary creatinine clearance is considered the most reliable method to detect ARC in critically ill patients. Augmented renal clearance is clearly associated with subtherapeutic antimicrobial concentrations and subsequent therapeutic failure. This warrants the need for adjusted dosing regimens to optimize pharmacokinetic and pharmacodynamic target attainment. This review aims to summarize current knowledge on ARC in critically ill children, to give insight into its possible pathophysiological mechanism, to evaluate screening methods for ARC in the pediatric intensive care population, and to illustrate the effect of ARC on drug exposure, therapeutic efficacy, and clinical outcome.
Keywords
Children, Critical illness, Intensive care, Glomerular filtration rate, Augmented renal clearance, Renal drug clearance, GLOMERULAR-FILTRATION-RATE, CRITICALLY-ILL PATIENTS, 24-HOUR CREATININE CLEARANCE, BETA-TRACE-PROTEIN, SERUM CYSTATIN C, POPULATION PHARMACOKINETICS, DEVELOPMENTAL PHARMACOLOGY, VANCOMYCIN CLEARANCE, FEBRILE NEUTROPENIA, CONTINUOUS-INFUSION

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 754.24 KB

Citation

Please use this url to cite or link to this publication:

MLA
Dhont, Evelyn, et al. “Augmented Renal Clearance in Pediatric Intensive Care : Are We Undertreating Our Sickest Patients?” PEDIATRIC NEPHROLOGY, vol. 35, no. 1, 2020, pp. 25–29.
APA
Dhont, E., Van Der Heggen, T., de Jaeger, A., Vande Walle, J., De Paepe, P., & De Cock, P. (2020). Augmented renal clearance in pediatric intensive care : are we undertreating our sickest patients? PEDIATRIC NEPHROLOGY, 35(1), 25–29.
Chicago author-date
Dhont, Evelyn, Tatjana Van Der Heggen, Annik de Jaeger, Johan Vande Walle, Peter De Paepe, and Pieter De Cock. 2020. “Augmented Renal Clearance in Pediatric Intensive Care : Are We Undertreating Our Sickest Patients?” PEDIATRIC NEPHROLOGY 35 (1): 25–29.
Chicago author-date (all authors)
Dhont, Evelyn, Tatjana Van Der Heggen, Annik de Jaeger, Johan Vande Walle, Peter De Paepe, and Pieter De Cock. 2020. “Augmented Renal Clearance in Pediatric Intensive Care : Are We Undertreating Our Sickest Patients?” PEDIATRIC NEPHROLOGY 35 (1): 25–29.
Vancouver
1.
Dhont E, Van Der Heggen T, de Jaeger A, Vande Walle J, De Paepe P, De Cock P. Augmented renal clearance in pediatric intensive care : are we undertreating our sickest patients? PEDIATRIC NEPHROLOGY. 2020;35(1):25–9.
IEEE
[1]
E. Dhont, T. Van Der Heggen, A. de Jaeger, J. Vande Walle, P. De Paepe, and P. De Cock, “Augmented renal clearance in pediatric intensive care : are we undertreating our sickest patients?,” PEDIATRIC NEPHROLOGY, vol. 35, no. 1, pp. 25–29, 2020.
@article{8585811,
  abstract     = {Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to assess renal function in critically ill children. Standard equations to calculate glomerular filtration rate (GFR) are developed for patients who have a steady-state creatinine production and a stable renal function. Those formulas are not reliable in critically ill patients with acutely changing GFR and tend to underestimate true GFR in patients with ARC. Tools for real-time, continuous, and non-invasive measurement of fluctuating GFR are most needed to identify changes in kidney function during critical illness and therapeutic interventions. Such devices are currently being validated and hold a strong potential to become the standard of practice. In the meantime, urinary creatinine clearance is considered the most reliable method to detect ARC in critically ill patients. Augmented renal clearance is clearly associated with subtherapeutic antimicrobial concentrations and subsequent therapeutic failure. This warrants the need for adjusted dosing regimens to optimize pharmacokinetic and pharmacodynamic target attainment. This review aims to summarize current knowledge on ARC in critically ill children, to give insight into its possible pathophysiological mechanism, to evaluate screening methods for ARC in the pediatric intensive care population, and to illustrate the effect of ARC on drug exposure, therapeutic efficacy, and clinical outcome.},
  author       = {Dhont, Evelyn and Van Der Heggen, Tatjana and de Jaeger, Annik and Vande Walle, Johan and De Paepe, Peter and De Cock, Pieter},
  issn         = {0931-041X},
  journal      = {PEDIATRIC NEPHROLOGY},
  keywords     = {Children,Critical illness,Intensive care,Glomerular filtration rate,Augmented renal clearance,Renal drug clearance,GLOMERULAR-FILTRATION-RATE,CRITICALLY-ILL PATIENTS,24-HOUR CREATININE CLEARANCE,BETA-TRACE-PROTEIN,SERUM CYSTATIN C,POPULATION PHARMACOKINETICS,DEVELOPMENTAL PHARMACOLOGY,VANCOMYCIN CLEARANCE,FEBRILE NEUTROPENIA,CONTINUOUS-INFUSION},
  language     = {eng},
  number       = {1},
  pages        = {25--29},
  title        = {Augmented renal clearance in pediatric intensive care : are we undertreating our sickest patients?},
  url          = {http://dx.doi.org/10.1007/s00467-018-4120-2},
  volume       = {35},
  year         = {2020},
}

Altmetric
View in Altmetric
Web of Science
Times cited: