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Drug Dosing in Critically Ill Adult Patients with Augmented Renal Clearance

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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.

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

    Fatma Hefny, Sukhvir Sambhi, Cassidy Morris, Anna Stuart & Sherif Hanafy Mahmoud

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

    Janice Y. Kung

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  1. Fatma Hefny
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Conceptualization and design, S.H.M.; database search, J.Y.K.; study screening and selection, S.H.M., A.S., S.S.; data extraction and summarization, F.H., C.M., S.S., A.S.; resolution of conflict in study selection and interpretation, S.H.M.; drafting the first version of the manuscript; C.M., S.S.; revision and approval of the final manuscript, all authors.

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Hefny, F., Sambhi, S., Morris, C. et al. Drug Dosing in Critically Ill Adult Patients with Augmented Renal Clearance. Eur J Drug Metab Pharmacokinet 47, 607–620 (2022). https://doi.org/10.1007/s13318-022-00779-4

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