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Augmented renal clearance: a common condition in critically ill children

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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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Acknowledgements

The authors thank Benjamin Leenknegt, Karlien Roelandt, and Nick Boeykens for their help with data collection.

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Authors and Affiliations

  1. Department of Pediatrics, Ghent University Hospital, 3K12D, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Tatjana Van Der Heggen, Evelyn Dhont & Johan Vande Walle

  2. Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

    Tatjana Van Der Heggen, Evelyn Dhont, Peter De Paepe & Pieter A. De Cock

  3. Department of Pediatric Intensive Care, Ghent University Hospital, Ghent, Belgium

    Evelyn Dhont & Pieter A. De Cock

  4. Department of Cardiac Intensive Care, Ghent University Hospital, Ghent, Belgium

    Harlinde Peperstraete

  5. Department of Laboratory Medicine, Ghent University, Ghent, Belgium

    Joris R. Delanghe

  6. Department of Pharmacy, Ghent University Hospital, Ghent, Belgium

    Peter De Paepe & Pieter A. De Cock

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  1. Tatjana Van Der Heggen
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  2. Evelyn Dhont
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  4. Joris R. Delanghe
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  5. Johan Vande Walle
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  7. Pieter A. De Cock
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Correspondence to Tatjana Van Der Heggen.

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This study was approved by the institutional ethics committee and written informed consent was obtained from the parents or legal representatives and from the patients older than 12 years.

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The authors declare that they have no conflict of interest.

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Van Der Heggen, T., Dhont, E., Peperstraete, H. et al. Augmented renal clearance: a common condition in critically ill children. Pediatr Nephrol 34, 1099–1106 (2019). https://doi.org/10.1007/s00467-019-04205-x

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  • DOI: https://doi.org/10.1007/s00467-019-04205-x

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