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