Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan.
Pharmacol Res Perspect. 2021 Apr;9(2):e00747. doi: 10.1002/prp2.747.
Augmented renal clearance (ARC) is a phenomenon that has been associated with enhanced excretion of renally eliminated drugs, such as antimicrobials, which may result in subtherapeutic levels and potentially therapeutic failure. There has been limited data on ARC in critically ill patients with cancer. This study aimed to evaluate the prevalence of ARC and to identify risk factors associated with ARC in this patient population. This was a prospective study at an oncologic intensive care unit (ICU) which included adult patients with normal renal function, defined as serum creatinine ≤1 mg/dl and urine output >0.5 ml/kg/hr. The 24-hour creatinine clearance (ClCr) study was used to determine ClCr, starting on day 1 of ICU admission, for 5 days or until ICU transfer or death. ARC was defined as ClCr >130 ml/min/1.73 m . Univariate and multivariate logistic regression analyses were performed to identify risk factors for ARC. Over the study period, 363 patients were enrolled who completed an average of 2.8 ± 1.5(SD) days in the study and contributed 977 ClCr measurements. The mean age was 52 ± 16(SD) years old, the majority had solid tumors (n = 264, 73%), mean APACHE II was 21 ± 8(SD), and the major admission diagnosis was respiratory failure (n = 165, 45%). ARC was reported in 116 (32%) patients on at least one of the study days. Over the study period, the incidence of ARC ranged between 15.6% and 24.3%. Age was the only risk factor significantly associated with ARC (OR 1.028, 95% CI 1.005-1.051).
增强的肾清除率 (ARC) 是一种与肾清除药物（如抗生素）排泄增强相关的现象，这可能导致治疗性水平降低，并可能导致治疗失败。在患有癌症的危重症患者中，ARC 的数据有限。本研究旨在评估该患者人群中 ARC 的患病率，并确定与 ARC 相关的危险因素。这是一项在肿瘤重症监护病房 (ICU) 进行的前瞻性研究，纳入了肾功能正常的成年患者，定义为血清肌酐≤1mg/dl 和尿量>0.5ml/kg/hr。24 小时肌酐清除率 (ClCr) 研究用于在 ICU 入院第 1 天开始，连续 5 天或直至 ICU 转科或死亡时，测定 ClCr。ARC 定义为 ClCr>130ml/min/1.73m 。进行了单因素和多因素逻辑回归分析，以确定 ARC 的危险因素。在研究期间，共纳入 363 例患者，平均在研究中完成 2.8±1.5（SD）天，共提供 977 次 ClCr 测量值。患者的平均年龄为 52±16（SD）岁，大多数为实体瘤（n=264，73%），平均急性生理学和慢性健康状况评分系统 II（APACHE II）评分为 21±8（SD），主要入院诊断为呼吸衰竭（n=165，45%）。至少在一个研究日报告了 116 例（32%）患者发生 ARC。在研究期间，ARC 的发生率在 15.6%至 24.3%之间。年龄是唯一与 ARC 显著相关的危险因素（OR 1.028，95%CI 1.005-1.051）。
