ESPN 51th Annual Meeting

ESPN 2018


 
Augmented renal clearance: surprisingly common in critically ill children
TATJANA VAN DER HEGGEN 1 EVELYN DHONT 1 JOHAN VANDE WALLE 1 PETER DE PAEPE 1 PIETER DE COCK 1

1- GHENT UNIVERSITY HOSPITAL, BELGIUM
 
Introduction:

Augmented renal clearance (ARC) is an increase in kidney function, resulting in the enhanced elimination of circulating solute including renally cleared drugs. This concept has been increasingly recognized in critically ill adults, whereas in a pediatric intensive care setting, research remains scarce. The primary objective of this study was to investigate the incidence of ARC in critically ill children. Additionally, risk factors for the development of ARC were analyzed.

Material and methods:

This study was a single center, prospective, observational study, conducted at the pediatric intensive care unit of the Ghent University Hospital, Belgium, enrolling patients between 1 month and 15 years of age. Glomerular filtration rate (GFR) was measured by means of a daily 24-hours creatinine clearance (24h ClCr), for a maximum of four consecutive days. ARC was defined as a GFR exceeding normal values for age plus two standard deviations. Logistic regression analysis was used to identify risk factors for ARC.

Results:

Data were collected from 105 patients (median age 1.4 years, IQR 2.5). Overall, 59% of patients expressed ARC and the incidence decreased on consecutive days. ARC patients had a median ClCr of 144.5 ml/min/1.73m² (IQR 47.1). Male gender and antibiotic treatment were independently associated with the occurrence of ARC. Patients after cardiac surgery were less likely to develop ARC. 

Conclusions:

A large proportion of critically ill children develops ARC during their stay at the intensive care unit. As ARC may lead to subtherapeutic treatment of renally eliminated drugs, early detection of patients at risk is important.