Abstract
Kidney function assessment in the critically ill overlooks the possibility for hyperfunctioning kidneys, known as augmented renal clearance (ARC), which could contribute to therapeutic failures in the intensive care unit (ICU). The aim of this research is to conduct a systematic review and meta-analysis of prevalence and risk factors of ARC in the critically ill. MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations and Theses Global databases were searched on 27 October 2020. We included studies conducted in critically ill adults who reported the prevalence and/or risk factors of ARC. We evaluated study quality using the Joanna Briggs Institute appraisal tool. Case reports, reviews, editorials and commentaries were excluded. We generated a random-effects meta-analytic model using the inverse variance method and visualized the pooled estimates using forest plots. Seventy studies were included. The pooled prevalence (95% CI) was 39% (34.9–43.3). Prevalence for neuro, trauma, mixed and sepsis ICUs were 74 (55–87), 58 (48–67), 36 (31–41) and 33 (21–48), respectively. Age, male sex and trauma were associated with ARC with pooled OR (95% CI) of 0.95 (0.93–0.96), 2.36 (1.28–4.36), 2.60 (1.21–5.58), respectively. Limitations included variations in ARC definition, inclusion and exclusion criteria and studies design. In conclusion, ARC is prevalent in critically ill patients, especially those in the neurocritical care and trauma ICU population. Young age, male sex and trauma are risk factors for ARC in those with apparently normal renal function. Further research on optimal dosing of drugs in the setting of ARC is warranted. (Prospero registration: CRD42021246417).
Highlights
Critical illness is unique for its complex nature, which very often requires a range of professional expertise to provide the most comprehensive care possible, the need for a multidisciplinary approach
This conventional view might be overlooking a third category of patients who may exhibit hyperfunctioning kidneys or what is known as augmented renal clearance (ARC)
Among the reported risk factors, age, male sex and trauma were significantly associated with ARC with pooled odds ratio estimates of 0.95 (0.93–0.96), 2.36 (1.28–4.36), and 2.60 (1.21–5.58), respectively (Figure 6)
Summary
Critical illness is unique for its complex nature, which very often requires a range of professional expertise to provide the most comprehensive care possible, the need for a multidisciplinary approach. When assessing a patient’s kidney function, in a critical care setting, clinicians typically consider one of two possibilities: either normal renal function, or renal impairment, with most of the attention paid towards dosing adjustments in the presence of impaired renal function and/or the use of renal replacement therapy This conventional view might be overlooking a third category of patients who may exhibit hyperfunctioning kidneys or what is known as augmented renal clearance (ARC). This phenomenon, while not yet fully understood, may potentially be the rationale behind a range of therapeutic failures for renally-eliminated drugs [1,2,3].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
