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危重症成人伴增强肾清除率患者的药物剂量调整。

Drug Dosing in Critically Ill Adult Patients with Augmented Renal Clearance.

机构信息

Katz Group Centre for Pharmacy and Health Research, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, 3-142H, Edmonton, AB, T6G 2E1, Canada.

Public Services Librarian, John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada.

出版信息

Eur J Drug Metab Pharmacokinet. 2022 Sep;47(5):607-620. doi: 10.1007/s13318-022-00779-4. Epub 2022 Jun 28.


DOI:10.1007/s13318-022-00779-4
PMID:35763238
Abstract

Augmented renal clearance (ARC) is a phenomenon of enhanced renal function seen in critically ill patients. ARC alters the disposition of renally eliminated medications currently used in the intensive care unit, resulting in underdosing and potential therapy failure. Our review addresses the rising concern of inadequate dosing in patients with ARC by summarizing the currently available evidence. To our knowledge, this guide is the first to provide clinicians with dose recommendation insights for renally eliminated agents in adult critically ill patients with ARC. A comprehensive literature search using MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and ProQuest Dissertations and Theses Global was conducted until 3 November 2021. Screening and data extraction were conducted in two steps: title and abstract screening followed by full-text review. Full text review resulted in a total of 51 studies included in this review. The results demonstrated the need for higher-than-standard doses for meropenem, imipenem, and vancomycin and reduced dosing intervals for ceftriaxone in patients with ARC. The potential need for increased dosing frequency in patients with ARC was also found for both enoxaparin and levetiracetam. In conclusion, ARC has been shown to influence the probability of target attainment in several medications requiring dosing changes to mitigate the risk of therapeutic failure.

摘要

增强的肾清除率(ARC)是一种在危重病患者中观察到的肾功能增强现象。ARC 改变了目前在重症监护病房中使用的经肾脏消除的药物的处置,导致剂量不足和潜在的治疗失败。我们的综述通过总结目前可用的证据,解决了对 ARC 患者剂量不足的日益关注。据我们所知,本指南是第一个为 ARC 的成年危重病患者提供有关经肾脏消除药物剂量建议的指南。使用 MEDLINE、Embase、Cochrane 图书馆、CINAHL、Scopus 和 ProQuest Dissertations 和 Theses Global 进行了全面的文献检索,检索时间截至 2021 年 11 月 3 日。筛选和数据提取分两步进行:标题和摘要筛选,然后是全文审查。全文审查共纳入 51 项研究。结果表明,ARC 患者需要更高的标准剂量来使用美罗培南、亚胺培南和万古霉素,以及更短的头孢曲松给药间隔。在 ARC 患者中,还发现需要增加依诺肝素和左乙拉西坦的给药频率。总之,ARC 已被证明会影响几种需要改变剂量以降低治疗失败风险的药物的靶标实现概率。

相似文献

[1]
Drug Dosing in Critically Ill Adult Patients with Augmented Renal Clearance.

Eur J Drug Metab Pharmacokinet. 2022-9

[2]
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?

Pediatr Nephrol. 2018-10-29

[3]
Are Antibiotics Appropriately Dosed in Critically Ill Patients with Augmented Renal Clearance? A Narrative Review.

Int J Clin Pract. 2022

[4]
Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing.

Pharmaceutics. 2017-9-16

[5]
Clinical Outcomes of Protocolized Antibiotic Dosing in Critically Ill Surgical Patients With Bacteremia and Augmented Renal Clearance Compared With Critically Ill Surgical Patients Without Augmented Renal Clearance.

Surg Infect (Larchmt). 2024-3

[6]
Treatment implications of augmented renal clearance in a critically ill COVID-19 patient: A case report.

Fundam Clin Pharmacol. 2023-10

[7]
Role of renal function in risk assessment of target non-attainment after standard dosing of meropenem in critically ill patients: a prospective observational study.

Crit Care. 2017-10-21

[8]
Augmented renal clearance of vancomycin and levetiracetam in a traumatic brain injury patient.

Neurocrit Care. 2013-10

[9]
Prevalence and Risk Factors of Augmented Renal Clearance: A Systematic Review and Meta-Analysis.

Pharmaceutics. 2022-2-19

[10]
Augmented Renal Clearance Following Traumatic Injury in Critically Ill Patients Requiring Nutrition Therapy.

Nutrients. 2021-5-15

引用本文的文献

[1]
Levetiracetam Dosing Optimization in Neurocritical Care Population: Neuro-ARC Study.

Neurocrit Care. 2025-9-4

[2]
Pharmacotherapy variability and precision medicine in neurocritical care.

Front Neurol. 2025-7-18

[3]
The Definition, Prevalence, and Risk Factors of Augmented Renal Clearance in Adult Patients on Antimicrobial Therapy: A Scoping Review.

Infect Dis Clin Microbiol. 2025-6-26

[4]
Evaluating Anti-factor X Levels in Patients with Augmented Renal Clearance Receiving Enoxaparin Prophylaxis: An Exploratory Pilot Study.

J Res Pharm Pract. 2025-6-13

[5]
Utilizing gentamicin concentrations to estimate glomerular filtration rate in intensive care unit patients.

Sci Rep. 2025-5-18

[6]
The Impact of Augmented Renal Clearance on the Pharmacokinetics of Levetiracetam in Critically Ill Patients: A Literature Review.

J Clin Pharmacol. 2025-7

[7]
Grand challenge in antibiotic pharmacology: A major step toward tailored antimicrobial treatment in very complex clinical scenarios of infectious risk management.

Front Antibiot. 2022-9-20

[8]
Clinical implications of augmented renal clearance after unrelated single cord blood transplantation in adults.

Int J Hematol. 2023-12

[9]
LC-MS/MS-Based Serum Metabolomics and Transcriptome Analyses for the Mechanism of Augmented Renal Clearance.

Int J Mol Sci. 2023-6-21

[10]
Metabolomic Analysis in Neurocritical Care Patients.

Metabolites. 2023-6-11

本文引用的文献

[1]
To blind or not to blind first in human and exploratory clinical trials: Acceleration of development vs. risk of bias.

Clin Transl Sci. 2022-3

[2]
Clinical applicability of urinary creatinine clearance for determining the initial dose of vancomycin in critically ill patients.

J Infect Chemother. 2022-2

[3]
Ceftolozane/tazobactam probability of target attainment and outcomes in participants with augmented renal clearance from the randomized phase 3 ASPECT-NP trial.

Crit Care. 2021-10-2

[4]
Pharmacokinetics of levetiracetam in neurosurgical ICU patients.

J Crit Care. 2021-8

[5]
Pharmacokinetics and Pharmacodynamics of Ceftolozane/Tazobactam in Critically Ill Patients With Augmented Renal Clearance.

Int J Antimicrob Agents. 2021-4

[6]
Meropenem at recommended dose is a potential risk for seizure in hemodialysis patient.

Saudi J Kidney Dis Transpl. 2020

[7]
Population Pharmacokinetics of Levetiracetam in Patients with Traumatic Brain Injury and Subarachnoid Hemorrhage Exhibiting Augmented Renal Clearance.

Clin Pharmacokinet. 2021-5

[8]
A higher dose of vancomycin is needed in critically ill patients with augmented renal clearance.

Transl Androl Urol. 2020-10

[9]
Effect of augmented renal clearance on the therapeutic drug monitoring of vancomycin in patients after neurosurgery.

J Int Med Res. 2020-10

[10]
Application of vancomycin in patients with augmented renal clearance.

Eur J Hosp Pharm. 2020-9

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