Tsai, D; Udy, A A; Stewart, Penny; Gourley, S; Morick, N M; Lipman, J; Roberts, J A

Author(s)

Tsai, D

Udy, A A

Stewart, Penny

Gourley, S

Morick, N M

Lipman, J

Roberts, J A

Publication Date

2018

Abstract

Augmented renal clearance (ARC) refers to the enhanced renal excretion of circulating solute commonly demonstrated in numerous critically ill subgroups. This study aimed to describe the prevalence of ARC in critically ill Indigenous Australian patients and explore the accuracy of commonly employed mathematical estimates of glomerular filtration. We completed a single-centre, prospective, observational study in the intensive care unit (ICU), Alice Springs Hospital, Central Australia. Participants were critically ill adult Indigenous and non-Indigenous Australian patients with a urinary catheter in situ. Exclusion criteria were anuria, pregnancy or the requirement for renal replacement therapy. Daily eight-hour measured creatinine clearances (CrCLm) were collected throughout the ICU stay. ARC was defined by a CrCLm ≥130 ml/min/1.73 m2. The Cockcroft-Gault and Chronic Kidney Disease Epidemiology Collaboration equations were also used to calculate mathematical estimates for comparison. In total, 131 patients were recruited (97 Indigenous, 34 non-Indigenous) and 445 samples were collected. The median (range) CrCLm was 93.0 (5.14 to 205.2) and 90.4 (18.7 to 206.8) ml/min/1.73 m2 in Indigenous and non-Indigenous patients, respectively. Thirty-one of 97 (32%) Indigenous patients manifested ARC, compared to 7 of 34 (21%) non-Indigenous patients (P=0.21). Younger age, major surgery, higher baseline renal function and an absence of diabetes were all associated with ARC. Both mathematical estimates manifest limited accuracy. ARC was prevalent in critically ill Indigenous patients, which places them at significant risk of underdosing with renally excreted drugs. CrCLm should be obtained wherever possible to ensure accurate dosing.

Citation

Tsai, D., Udy, A. A., Stewart, P. C., Gourley, S., Morick, N. M., Lipman, J., & Roberts, J. A. (2018). Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission. Anaesthesia and intensive care, 46(1), 42–50. https://doi.org/10.1177/0310057X1804600107

ISSN

0310-057X

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/29361255/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/5149

Subject

Indigenous

creatinine clearance

critically ill

glomerular filtration rate

intensive care

MESH subject

Australia

Cohort Studies

Creatinine

Critical Care

Female

Glomerular Filtration Rate

Humans

Length of Stay

Male

Middle Aged

Prevalence

Prospective Studies

Renal Insufficiency, Chronic

Title

Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Tsai, D Udy, A A Stewart, Penny Gourley, S Morick, N M Lipman, J Roberts, J A
Publication Date	2018
Abstract	Augmented renal clearance (ARC) refers to the enhanced renal excretion of circulating solute commonly demonstrated in numerous critically ill subgroups. This study aimed to describe the prevalence of ARC in critically ill Indigenous Australian patients and explore the accuracy of commonly employed mathematical estimates of glomerular filtration. We completed a single-centre, prospective, observational study in the intensive care unit (ICU), Alice Springs Hospital, Central Australia. Participants were critically ill adult Indigenous and non-Indigenous Australian patients with a urinary catheter in situ. Exclusion criteria were anuria, pregnancy or the requirement for renal replacement therapy. Daily eight-hour measured creatinine clearances (CrCL<sub>m</sub>) were collected throughout the ICU stay. ARC was defined by a CrCL<sub>m</sub> ≥130 ml/min/1.73 m<sup>2</sup>. The Cockcroft-Gault and Chronic Kidney Disease Epidemiology Collaboration equations were also used to calculate mathematical estimates for comparison. In total, 131 patients were recruited (97 Indigenous, 34 non-Indigenous) and 445 samples were collected. The median (range) CrCL<sub>m</sub> was 93.0 (5.14 to 205.2) and 90.4 (18.7 to 206.8) ml/min/1.73 m<sup>2</sup> in Indigenous and non-Indigenous patients, respectively. Thirty-one of 97 (32%) Indigenous patients manifested ARC, compared to 7 of 34 (21%) non-Indigenous patients (<i>P</i>=0.21). Younger age, major surgery, higher baseline renal function and an absence of diabetes were all associated with ARC. Both mathematical estimates manifest limited accuracy. ARC was prevalent in critically ill Indigenous patients, which places them at significant risk of underdosing with renally excreted drugs. CrCL<sub>m</sub> should be obtained wherever possible to ensure accurate dosing.
Citation	Tsai, D., Udy, A. A., Stewart, P. C., Gourley, S., Morick, N. M., Lipman, J., & Roberts, J. A. (2018). Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission. Anaesthesia and intensive care, 46(1), 42–50. https://doi.org/10.1177/0310057X1804600107
ISSN	0310-057X
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/29361255/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/5149
Subject	Indigenous creatinine clearance critically ill glomerular filtration rate intensive care
MESH subject	Australia Cohort Studies Creatinine Critical Care Female Glomerular Filtration Rate Humans Length of Stay Male Middle Aged Prevalence Prospective Studies Renal Insufficiency, Chronic
Title	Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission.
Type of document	Journal Article
Entity Type	Publication

Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission.

Files: