Augmented Renal Clearance in Critically Ill Patients: A Systematic Review

Area of Science:

• Critical care medicine
• Pharmacokinetics
• Nephrology

Background:

• Renal function assessment is standard in critically ill patients.
• Augmented renal clearance (ARC) can cause faster drug elimination, leading to subtherapeutic concentrations and poor outcomes.
• ARC is a less understood phenomenon compared to renal dysfunction.

Purpose of the Study:

• To systematically review evidence on ARC in critically ill patients.
• To summarize ARC's definition, mechanisms, epidemiology, diagnosis, and impact on drug pharmacokinetics and clinical outcomes.

Main Methods:

• Systematic review of original studies on ARC in critically ill patients.
• Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Main Results:

• ARC, defined as creatinine clearance (CrCl) > 130 mL/min/1.73 m², affects 20-65% of critically ill patients.
• Younger age, polytrauma, and lower illness severity are risk factors for ARC.
• ARC is associated with subtherapeutic antibiotic plasma concentrations, impacting antimicrobial pharmacokinetics.

Conclusions:

• ARC is prevalent in critically ill patients, particularly younger individuals.
• Urinary CrCl is the preferred diagnostic method for ARC, as estimations can underestimate clearance.
• Further research is needed to define ARC's impact on clinical outcomes and non-antimicrobial drug pharmacokinetics, and to establish specific dosing guidelines.