Incidence and clinical outcomes of critically ill patients with augmented renal clearance: A retrospective cohort

Abstract

Introduction: Although glomerular hyperfiltration in augmented renal clearance (ARC) results in suboptimal exposure to medications, its association with clinical outcomes is less clear. This study aimed to evaluate the incidence and clinical outcomes of ARC in an intensive care unit (ICU) population. Methods: This retrospective cohort included all ICU patients admitted between July 1, 2018, and June 30, 2019. The primary outcome was the incidence of ARC, defined as a creatinine clearance  of 130 mL/min/1.73 m2, for at least one day. Secondary outcomes included mechanical ventilation (MV) duration, ICU length of stay (LOS), in-hospital and 30-day mortality, acute kidney injury (AKI), and development of a multidrug-resistant (MDR) pathogen. Results: A total of 561 patients were included. The study population was 55% male (n=308), with a median age of 64 [IQR 53-74] years, a median baseline serum creatinine of 0.9 mg/dL [IQR 0.7-1.0], and primarily medical ICU population (n=396, 71%). The incidence of ARC was 25% (n=139). While there was no difference in MV duration, the ARC group had a longer ICU LOS (median [IQR] 6 [4-9] vs. 5 [4-8] days, p<0.001), and more MDR pathogens (22% vs. 9%, p<0.001). In-hospital mortality (6% vs. 12%, p=0.041), 30-day mortality (10% vs. 21%, p=0.005), and AKI (13% vs. 21%, p=0.027) were lower in patients with ARC. Conclusion: The incidence of ARC in this general ICU population was 25%. Differences in the clinical outcomes of patients with ARC should be further investigated.