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Augmented renal clearance : a common condition in critically ill children

Tatjana Van Der Heggen (UGent) , Evelyn Dhont (UGent) , Harlinde Peperstraete (UGent) , Joris Delanghe (UGent) , Johan Vande Walle (UGent) , Peter De Paepe (UGent) and Pieter De Cock (UGent)
(2019) PEDIATRIC NEPHROLOGY. 34(6). p.1099-1106
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IWT SBO 130033: SAFE-PEDRUG: Integrating multidisciplinary translational bottom-up approaches towards a new paradigm for paedriatic investigations: the next step in ethical paediatric drug research
Abstract
Background: Augmented renal clearance (ARC), an increase in kidney function with enhanced elimination of circulating solute, has been increasingly recognized in critically ill adults. In a pediatric intensive care setting, data are scarce. The primary objective of this study was to investigate the prevalence of ARC in critically ill children. Secondary objectives included a risk factor analysis for the development of ARC and a comparison of two methods for assessment of renal function. Methods: In 105 critically ill children between 1 month and 15 years of age, glomerular filtration rate (GFR) was measured by means of a daily 24-h creatinine clearance (24h Cl-Cr) and compared to an estimated GFR using the revised Schwartz formula. Logistic regression analysis was used to identify risk factors for ARC. Results: Overall, 67% of patients expressed ARC and the proportion of ARC patients decreased during consecutive days. ARC patients had a median Cl-Cr of 142.2 ml/min/1.73m(2) (IQR 47.1). Male gender and antibiotic treatment were independently associated with the occurrence of ARC. The revised Schwartz formula seems less appropriate for ARC detection. Conclusions: A large proportion of critically ill children develop ARC during their stay at the intensive care unit. Clinicians should be cautious when using Schwartz formula to detect ARC. Our findings require confirmation from large study cohorts and investigation of the relationship with clinical outcome.
Keywords
Pediatric intensive care, Critically ill children, Renal function, Glomerular filtration rate, Augmented renal clearance, Risk factors, GLOMERULAR-FILTRATION-RATE, CLINICAL-OUTCOMES, CREATININE, ICU, PIPERACILLIN, SURGERY, RISK

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Chicago
Van Der Heggen, Tatjana, Evelyn Dhont, Harlinde Peperstraete, Joris Delanghe, Johan Vande Walle, Peter De Paepe, and Pieter De Cock. 2019. “Augmented Renal Clearance : a Common Condition in Critically Ill Children.” Pediatric Nephrology 34 (6): 1099–1106.
APA
Van Der Heggen, T., Dhont, E., Peperstraete, H., Delanghe, J., Vande Walle, J., De Paepe, P., & De Cock, P. (2019). Augmented renal clearance : a common condition in critically ill children. PEDIATRIC NEPHROLOGY, 34(6), 1099–1106.
Vancouver
1.
Van Der Heggen T, Dhont E, Peperstraete H, Delanghe J, Vande Walle J, De Paepe P, et al. Augmented renal clearance : a common condition in critically ill children. PEDIATRIC NEPHROLOGY. 2019;34(6):1099–106.
MLA
Van Der Heggen, Tatjana et al. “Augmented Renal Clearance : a Common Condition in Critically Ill Children.” PEDIATRIC NEPHROLOGY 34.6 (2019): 1099–1106. Print.
@article{8605489,
  abstract     = {Background: Augmented renal clearance (ARC), an increase in kidney function with enhanced elimination of circulating solute, has been increasingly recognized in critically ill adults. In a pediatric intensive care setting, data are scarce. The primary objective of this study was to investigate the prevalence of ARC in critically ill children. Secondary objectives included a risk factor analysis for the development of ARC and a comparison of two methods for assessment of renal function. 
Methods: In 105 critically ill children between 1 month and 15 years of age, glomerular filtration rate (GFR) was measured by means of a daily 24-h creatinine clearance (24h Cl-Cr) and compared to an estimated GFR using the revised Schwartz formula. Logistic regression analysis was used to identify risk factors for ARC. 
Results: Overall, 67% of patients expressed ARC and the proportion of ARC patients decreased during consecutive days. ARC patients had a median Cl-Cr of 142.2 ml/min/1.73m(2) (IQR 47.1). Male gender and antibiotic treatment were independently associated with the occurrence of ARC. The revised Schwartz formula seems less appropriate for ARC detection. 
Conclusions: A large proportion of critically ill children develop ARC during their stay at the intensive care unit. Clinicians should be cautious when using Schwartz formula to detect ARC. Our findings require confirmation from large study cohorts and investigation of the relationship with clinical outcome.},
  author       = {Van Der Heggen, Tatjana and Dhont, Evelyn and Peperstraete, Harlinde and Delanghe, Joris and Vande Walle, Johan and De Paepe, Peter and De Cock, Pieter},
  issn         = {0931-041X},
  journal      = {PEDIATRIC NEPHROLOGY},
  keywords     = {Pediatric intensive care,Critically ill children,Renal function,Glomerular filtration rate,Augmented renal clearance,Risk factors,GLOMERULAR-FILTRATION-RATE,CLINICAL-OUTCOMES,CREATININE,ICU,PIPERACILLIN,SURGERY,RISK},
  language     = {eng},
  number       = {6},
  pages        = {1099--1106},
  title        = {Augmented renal clearance : a common condition in critically ill children},
  url          = {http://dx.doi.org/10.1007/s00467-019-04205-x},
  volume       = {34},
  year         = {2019},
}

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