Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment

Autores
Campassi, María Luz; Gonzalez, María Cecilia; Masevicius, Fabio Daniel; Risso Vazquez, Alejandro; Moseinco, Miriam; Navarro, Noelia Cintia; Previgliano, Luciana; Rubatto, Nahuel Paolo; Benites, Martín Hernán; Estenssoro, Elisa; Dubin, Arnaldo
Año de publicación
2014
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
Facultad de Ciencias Médicas
Materia
Ciencias Médicas
Creatinine
Metabolic clearance rate
Sepsis/drug therapy
Vancomycin/pharmacokinetics
Vancomycin/therapeutic use
Nivel de accesibilidad
acceso abierto
Condiciones de uso
http://creativecommons.org/licenses/by-nc-sa/4.0/
Repositorio
SEDICI (UNLP)
Institución
Universidad Nacional de La Plata
OAI Identificador
oai:sedici.unlp.edu.ar:10915/85624

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oai_identifier_str oai:sedici.unlp.edu.ar:10915/85624
network_acronym_str SEDICI
repository_id_str 1329
network_name_str SEDICI (UNLP)
spelling Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatmentIncremento da depuração renal em pacientes gravemente enfermos: Incidência, fatores associados e efeitos no tratamento com vancomicinaCampassi, María LuzGonzalez, María CeciliaMasevicius, Fabio DanielRisso Vazquez, AlejandroMoseinco, MiriamNavarro, Noelia CintiaPrevigliano, LucianaRubatto, Nahuel PaoloBenites, Martín HernánEstenssoro, ElisaDubin, ArnaldoCiencias MédicasCreatinineMetabolic clearance rateSepsis/drug therapyVancomycin/pharmacokineticsVancomycin/therapeutic useObjective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.Facultad de Ciencias Médicas2014info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionArticulohttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdf13-20http://sedici.unlp.edu.ar/handle/10915/85624enginfo:eu-repo/semantics/altIdentifier/issn/0103-507Xinfo:eu-repo/semantics/altIdentifier/doi/10.5935/0103-507X.20140003info:eu-repo/semantics/openAccesshttp://creativecommons.org/licenses/by-nc-sa/4.0/Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)reponame:SEDICI (UNLP)instname:Universidad Nacional de La Platainstacron:UNLP2025-09-29T11:16:24Zoai:sedici.unlp.edu.ar:10915/85624Institucionalhttp://sedici.unlp.edu.ar/Universidad públicaNo correspondehttp://sedici.unlp.edu.ar/oai/snrdalira@sedici.unlp.edu.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:13292025-09-29 11:16:25.296SEDICI (UNLP) - Universidad Nacional de La Platafalse
dc.title.none.fl_str_mv Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
Incremento da depuração renal em pacientes gravemente enfermos: Incidência, fatores associados e efeitos no tratamento com vancomicina
title Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
spellingShingle Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
Campassi, María Luz
Ciencias Médicas
Creatinine
Metabolic clearance rate
Sepsis/drug therapy
Vancomycin/pharmacokinetics
Vancomycin/therapeutic use
title_short Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
title_full Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
title_fullStr Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
title_full_unstemmed Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
title_sort Augmented renal clearance in critically ill patients: Incidence, associated factors and effects on vancomycin treatment
dc.creator.none.fl_str_mv Campassi, María Luz
Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Risso Vazquez, Alejandro
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
author Campassi, María Luz
author_facet Campassi, María Luz
Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Risso Vazquez, Alejandro
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
author_role author
author2 Gonzalez, María Cecilia
Masevicius, Fabio Daniel
Risso Vazquez, Alejandro
Moseinco, Miriam
Navarro, Noelia Cintia
Previgliano, Luciana
Rubatto, Nahuel Paolo
Benites, Martín Hernán
Estenssoro, Elisa
Dubin, Arnaldo
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Ciencias Médicas
Creatinine
Metabolic clearance rate
Sepsis/drug therapy
Vancomycin/pharmacokinetics
Vancomycin/therapeutic use
topic Ciencias Médicas
Creatinine
Metabolic clearance rate
Sepsis/drug therapy
Vancomycin/pharmacokinetics
Vancomycin/therapeutic use
dc.description.none.fl_txt_mv Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
Facultad de Ciencias Médicas
description Objective: An augmented renal clearance has been described in some groups of critically ill patients, and it might induce sub-optimal concentrations of drugs eliminated by glomerular filtration, mainly antibiotics. Studies on its occurrence and determinants are lacking. Our goals were to determine the incidence and associated factors of augmented renal clearance and the efects on vancomycin concentrations and dosing in a series of intensive care unit patients. Methods: We prospectively studied 363 patients admitted during 1 year to a clinical-surgical intensive care unit. Patients with serum creatinine >1.3mg/dL were excluded. Creatinine clearance was calculated from a 24-hour urine collection. Patients were grouped according to the presence of augmented renal clearance (creatinine clearance >120mL/min/1.73m2), and possible risk factors were analyzed with bivariate and logistic regression analysis. In patients treated with vancomycin, dosage and plasma concentrations were registered. Results: Augmented renal clearance was present in 103 patients (28%); they were younger (48±15 versus 65±17 years, p>0.0001), had more frequent obstetric (16 versus 7%, p=0.0006) and trauma admissions (10 versus 3%, p=0.016) and fewer comorbidities. The only independent determinants for the development of augmented renal clearance were age (OR 0.95; p<0.0001; 95%CI 0.93-0.96) and absence of diabetes (OR 0.34; p=0.03; 95%CI 0.12-0.92). Twelve of the 46 patients who received vancomycin had augmented renal clearance and despite higher doses, had lower concentrations. Conclusions: In this cohort of critically ill patients, augmented renal clearance was a common finding. Age and absence of diabetes were the only independent determinants. Therefore, younger and previously healthy patients might require larger vancomycin dosing.
publishDate 2014
dc.date.none.fl_str_mv 2014
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
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info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://sedici.unlp.edu.ar/handle/10915/85624
url http://sedici.unlp.edu.ar/handle/10915/85624
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/issn/0103-507X
info:eu-repo/semantics/altIdentifier/doi/10.5935/0103-507X.20140003
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
http://creativecommons.org/licenses/by-nc-sa/4.0/
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
eu_rights_str_mv openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-sa/4.0/
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0)
dc.format.none.fl_str_mv application/pdf
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repository.name.fl_str_mv SEDICI (UNLP) - Universidad Nacional de La Plata
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