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Pediatric Nephrology
Published in: Pediatric Nephrology 6/2019

01-06-2019 | Antibiotic | Original Article

Augmented renal clearance: a common condition in critically ill children

Authors: Tatjana Van Der Heggen, Evelyn Dhont, Harlinde Peperstraete, Joris R. Delanghe, Johan Vande Walle, Peter De Paepe, Pieter A. De Cock

Published in: Pediatric Nephrology | Issue 6/2019

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Abstract

Background

Augmented renal clearance (ARC), an increase in kidney function with enhanced elimination of circulating solute, has been increasingly recognized in critically ill adults. In a pediatric intensive care setting, data are scarce. The primary objective of this study was to investigate the prevalence of ARC in critically ill children. Secondary objectives included a risk factor analysis for the development of ARC and a comparison of two methods for assessment of renal function.

Methods

In 105 critically ill children between 1 month and 15 years of age, glomerular filtration rate (GFR) was measured by means of a daily 24-h creatinine clearance (24 h ClCr) and compared to an estimated GFR using the revised Schwartz formula. Logistic regression analysis was used to identify risk factors for ARC.

Results

Overall, 67% of patients expressed ARC and the proportion of ARC patients decreased during consecutive days. ARC patients had a median ClCr of 142.2 ml/min/1.73m2 (IQR 47.1). Male gender and antibiotic treatment were independently associated with the occurrence of ARC. The revised Schwartz formula seems less appropriate for ARC detection.

Conclusions

A large proportion of critically ill children develop ARC during their stay at the intensive care unit. Clinicians should be cautious when using Schwartz formula to detect ARC. Our findings require confirmation from large study cohorts and investigation of the relationship with clinical outcome.
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Metadata
Title
Augmented renal clearance: a common condition in critically ill children
Authors
Tatjana Van Der Heggen
Evelyn Dhont
Harlinde Peperstraete
Joris R. Delanghe
Johan Vande Walle
Peter De Paepe
Pieter A. De Cock
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 6/2019
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-019-04205-x

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