Augmented renal clearance. An unnoticed relevant event.
Por:
Tomasa-Irriguible TM, Sabater-Riera J, Pérez-Carrasco M, Ortiz-Ballujera P, Díaz-Buendía Y, Navas-Pérez A, Betbesé-Roig A, Rodríguez-López M, Ibarz-Vilamayor M, Olmo-Isasmendi A, Oliva-Zelaya I, Rovira-Anglès C, Cano-Hernández S, Vendrell-Torra E, Catalan-Ibars RM, Miralbés-Torner M, González de Molina J, Xirgu-Cortacans J and Marcos-Neira P
Publicada:
1 abr 2021
Resumen:
Augmented renal clearance (ARC) is a phenomenon that can lead to a therapeutic failure of those drugs of renal clearance. The purpose of the study was to ascertain the prevalence of ARC in the critically ill patient, to study the glomerular filtration rate (GFR) throughout the follow-up and analyze the concordance between the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimation formula and measured GFR. Observational, prospective, multicenter study. ARC was defined as a creatinine clearance greater than 130 ml/min/1.73 m(2). Eighteen hospitals were recruited. GFR measurements carried out twice weekly during a 2-month follow-up period. A total of 561 patients were included. ARC was found to have a non-negligible prevalence of 30%. More even, up to 10.7% already had ARC at intensive care unit (ICU) admission. No specific pattern of GFR was found during the follow-up. Patients in the ARC group were younger 56.5 (53.5-58.5) versus 66 (63.5-68.5) years than in the non-ARC group, p < 0.001. ICU mortality was lower in the ARC group, 6.9% versus 14.5%, p = 0.003. There was no concordance between the estimation of GFR by the CKD-EPI formula and GFR calculated from the 4-h urine. ARC is found in up to 30% of ICU patients, so renal removal drugs could be under dosed by up to 30%. And ARC is already detected on admission in 10%. It is a dynamic phenomenon without an established pattern that usually occurs in younger patients that can last for several weeks. And the CKD-EPI formula does not work to estimate the real creatinine clearance of these patients.
Filiaciones:
:
Intensive Care Department, Germans Trias i Pujol Hospital, Barcelona, Spain
Sabater-Riera J:
Intensive Care Department, Bellvitge Hospital, Barcelona, Spain
Pérez-Carrasco M:
Intensive Care Department, Vall d'Hebron Hospital, Barcelona, Spain
Ortiz-Ballujera P:
Intensive Care Department, Josep Trueta Hospital, Girona, Spain
Díaz-Buendía Y:
Intensive Care Department, Parc de Salut Mar Hospital, Barcelona, Spain
Navas-Pérez A:
Intensive Care Department, Corporació Sanitària Parc Taulí, Sabadell, Spain
Betbesé-Roig A:
Intensive Care Department, Santa Creu i Sant Pau Hospital, Barcelona, Spain
Rodríguez-López M:
Intensive Care Department, Moïsès Broggi Hospital, Sant Joan Despí, Spain
Ibarz-Vilamayor M:
Intensive Care Department, Sagrat Cor University Hospital, Barcelona, Spain
Olmo-Isasmendi A:
Intensive Care Department, General de Catalunya Hospital, Sant Cugat del Vallès, Spain
Oliva-Zelaya I:
Intensive Care Department, Joan XXIII Hospital, Tarragona, Spain
Rovira-Anglès C:
Intensive Care Department, Sant Joan Hospital, Reus, Spain
Cano-Hernández S:
Intensive Care Department, Fundació Althaia Xarxa Assistencial Universitària, Manresa, Spain
Vendrell-Torra E:
Intensive Care Department, Mataró Hospital, Catalunya, Spain
Catalan-Ibars RM:
Intensive Care Department, Vic-CHV General Hospital, Vic, Spain
Miralbés-Torner M:
Intensive Care Department, Arnau de Vilanova Hospital, Lleida, Spain
González de Molina J:
Intensive Care Department, Mútua de Terrassa Hospital, Terrassa, Spain
Xirgu-Cortacans J:
Intensive Care Department, Granollers Hospital, Granollers, Spain
Marcos-Neira P:
Intensive Care Department, Germans Trias i Pujol Hospital, Barcelona, Spain
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