Predicting augmented renal clearance using estimated glomerular filtration rate in critically-ill children


Area of Science:

• Pharmacokinetics and Pharmacodynamics
• Nephrology
• Pediatric Critical Care

Background:

• Measured glomerular filtration rate (mGFR) is standard for identifying augmented renal clearance (ARC), crucial for vancomycin dosing.
• Estimated GFR (eGFR) offers a quicker, more accessible alternative in clinical settings.

Purpose of the Study:

• To evaluate the correlation between eGFR and vancomycin trough levels (VTL).
• To determine if eGFR can reliably identify ARC in pediatric patients.

Main Methods:

• Retrospective analysis of 101 pediatric patients undergoing vancomycin therapeutic drug monitoring.
• Analysis of VTL, serum creatinine, eGFR, and influencing clinical factors.

Main Results:

• A significant correlation was found between eGFR and VTL (adjusted R ² = 0.812, p < 0.001).
• Increased eGFR was a risk factor for subtherapeutic vancomycin levels (OR = 1.002, p = 0.001).
• An eGFR cutoff of 110.51 mL/min/1.73m ² predicted subtherapeutic vancomycin levels (AUC = 0.753).

Conclusions:

• eGFR is a reliable and efficient alternative to mGFR for identifying ARC in pediatric patients.
• eGFR can predict subtherapeutic vancomycin levels, aiding in optimized dosing.