Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10199
Title: Prevalence of augmented renal clearance and performance of glomerular filtration estimates in Indigenous Australian patients requiring intensive care admission.
Authors: Tsai, D
Udy, A A
Stewart, P C
Gourley, S
Morick, N M
Lipman, J
Roberts, J A
Affiliation: Burns, Trauma and Critical Care Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Department of Intensive Care Medicine, Pharmacy Department, Alice Springs Hospital, Alice Springs, Northern Territory..
Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria..
Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, Northern Territory..
Emergency Department, Alice Springs Hospital, Alice Springs, Northern Territory..
Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, Northern Territory..
Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Department of Intensive Care Medicine, Pharmacy Department, Emergency Department, Alice Springs Hospital, Alice Springs, Northern Territory; Department of Intensive Care and Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria..
Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital..
Issue Date: 2018
Citation: Anaesthesia and intensive care 2018; 46(1): 42-50
Abstract: Augmented renal clearance (ARC) refers to the enhanced renal excretion of circulating solute commonly demonstrated in numerous critically ill subgroups. This study aimed to describe the prevalence of ARC in critically ill Indigenous Australian patients and explore the accuracy of commonly employed mathematical estimates of glomerular filtration. We completed a single-centre, prospective, observational study in the intensive care unit (ICU), Alice Springs Hospital, Central Australia. Participants were critically ill adult Indigenous and non-Indigenous Australian patients with a urinary catheter in situ. Exclusion criteria were anuria, pregnancy or the requirement for renal replacement therapy. Daily eight-hour measured creatinine clearances (CrCL<sub>m</sub>) were collected throughout the ICU stay. ARC was defined by a CrCL<sub>m</sub> ≥130 ml/min/1.73 m<sup>2</sup>. The Cockcroft-Gault and Chronic Kidney Disease Epidemiology Collaboration equations were also used to calculate mathematical estimates for comparison. In total, 131 patients were recruited (97 Indigenous, 34 non-Indigenous) and 445 samples were collected. The median (range) CrCL<sub>m</sub> was 93.0 (5.14 to 205.2) and 90.4 (18.7 to 206.8) ml/min/1.73 m<sup>2</sup> in Indigenous and non-Indigenous patients, respectively. Thirty-one of 97 (32%) Indigenous patients manifested ARC, compared to 7 of 34 (21%) non-Indigenous patients (<i>P</i>=0.21). Younger age, major surgery, higher baseline renal function and an absence of diabetes were all associated with ARC. Both mathematical estimates manifest limited accuracy. ARC was prevalent in critically ill Indigenous patients, which places them at significant risk of underdosing with renally excreted drugs. CrCL<sub>m</sub> should be obtained wherever possible to ensure accurate dosing.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10199
ISSN: 0310-057X
Type: Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Subjects: Indigenous
creatinine clearance
critically ill
glomerular filtration rate
intensive care
Australia
Cohort Studies
Creatinine
Critical Care
Female
Glomerular Filtration Rate
Humans
Length of Stay
Male
Middle Aged
Prevalence
Prospective Studies
Renal Insufficiency, Chronic
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