1Burns, Trauma, and Critical Care Research Centre, The University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. 2Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia. 3Serviço de Medicina Intensiva, Hospitais da Universidade de Coimbra, EPE Praceta Prof. Mota Pinto, Coimbra, Portugal. 4Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore. 5Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin NT, Hong Kong SAR. 6Statistics Unit, Level 3 Clive Berghofer Cancer Research Centre, Queensland Institute of Medical Research, Herston, QLD, Australia.
Crit Care Med. 2014 Mar;42(3):520-7. doi: 10.1097/CCM.0000000000000029.
To describe the prevalence and natural history of augmented renal clearance in a cohort of recently admitted critically ill patients with normal plasma creatinine concentrations.
Multicenter, prospective, observational study.
Four, tertiary-level, university-affiliated, ICUs in Australia, Singapore, Hong Kong, and Portugal.
Study participants had to have an expected ICU length of stay more than 24 hours, no evidence of absolute renal impairment (admission plasma creatinine < 120 µmol/L), and no history of prior renal replacement therapy or chronic kidney disease. Convenience sampling was used at each participating site.
Eight-hour urinary creatinine clearances were collected daily, as the primary method of measuring renal function. Augmented renal clearance was defined by a creatinine clearance more than or equal to 130 mL/min/1.73 m. Additional demographic, physiological, therapeutic, and outcome data were recorded prospectively.
Nine hundred thirty-two patients were admitted to the participating ICUs over the study period, and 281 of which were recruited into the study, contributing 1,660 individual creatinine clearance measures. The mean age (95% CI) was 54.4 years (52.5-56.4 yr), Acute Physiology and Chronic Health Evaluation II score was 16 (15.2-16.7), and ICU mortality was 8.5%. Overall, 65.1% manifested augmented renal clearance on at least one occasion during the first seven study days; the majority (74%) of whom did so on more than or equal to 50% of their creatinine clearance measures. Using a mixed-effects model, the presence of augmented renal clearance on study day 1 strongly predicted (p = 0.019) sustained elevation of creatinine clearance in these patients over the first week in ICU.
Augmented renal clearance appears to be a common finding in this patient group, with sustained elevation of creatinine clearance throughout the first week in ICU. Future studies should focus on the implications for accurate dosing of renally eliminated pharmaceuticals in patients with augmented renal clearance, in addition to the potential impact on individual clinical outcomes.
描述在一组血浆肌酐浓度正常的新近入住重症监护病房的危重病患者中，增强的肾清除率的流行率和自然史。
多中心、前瞻性、观察性研究。
澳大利亚、新加坡、中国香港和葡萄牙的四个三级、大学附属的重症监护病房。
研究参与者必须有超过 24 小时的 ICU 住院预期，没有绝对肾功能损害的证据（入院时血浆肌酐<120µmol/L），并且没有先前的肾脏替代治疗或慢性肾病病史。在每个参与地点都采用了方便抽样。
每天收集 8 小时尿液肌酐清除率，作为测量肾功能的主要方法。增强的肾清除率定义为肌酐清除率大于或等于 130mL/min/1.73m。还前瞻性记录了其他人口统计学、生理学、治疗和结局数据。
在研究期间，932 名患者入住了参与的 ICU，其中 281 名患者被招募入组，共提供了 1660 次单独的肌酐清除率测量值。平均年龄（95%CI）为 54.4 岁（52.5-56.4 岁），急性生理学和慢性健康评估 II 评分 16 分（15.2-16.7），ICU 死亡率为 8.5%。总体而言，65.1%的患者在研究的前 7 天至少有一次出现增强的肾清除率；其中大多数（74%）患者在其肌酐清除率测量值的 50%以上出现增强的肾清除率。使用混合效应模型，第 1 天存在增强的肾清除率强烈预测（p=0.019）这些患者在 ICU 第一周内肌酐清除率持续升高。
增强的肾清除率似乎是该患者群体中的常见现象，在 ICU 第一周内肌酐清除率持续升高。未来的研究应重点关注增强的肾清除率对肾清除药物准确剂量的影响，以及对个体临床结局的潜在影响。
