Augmented Renal Clearance in The Intensive Care Unit - A Multicenter Study

An observation study of creatinine clearance in patients admitted to the intensive care unit for a duration greater than twenty-four hours.

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12610000116022

Acronym

ARCTICUS

Enrollment

281

Registered

2010-02-03

Start date

2010-04-05

Completion date

2011-02-16

Last updated

2020-01-13

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

The kidneys have a range of essential functions in the body. Central to their role in the excretion of waste products and pharmaceuticals is the filtration of plasma (the non-cellular component of blood). During this process, substances (such as glucose, amino acids, electrolytes, waste products and some drugs) leave the circulation and enter the renal tubule. Subsequently, drugs / metabolites can be added to or reabsorbed from the filtrate as it passes along the tubule prior to excretion in the urine. In this manner the kidney is responsible for the elimination of a wide range of drugs and toxins. The rate at which plasma is filtered by the kidneys is referred to as the glomerular filtration rate (GFR) and is largely determined by renal blood blow (RBF). Ideal filtration markers (substances that are only filtered and neither secreted nor reabsorbed by the kidneys) are used to accurately measure GFR (eg Sinistrin), although are not routinely available in a clinical setting. Creatinine is a small molecular weight amino acid derivative that is freely filtered and secreted (10%) by the kidneys. A clinically useful measure of GFR involves calculating a timed creatinine clearance, which reflects the rate at which plasma is cleared of creatinine over a given period of time. Although research has largely focused on patients with declining renal function, there has been little attention on those with augmented renal clearances (ARC). We believe this phenomenon is likely to be common in patients on admission to the intensive care unit, and to date, has been largely under appreciated, although the implications are significant. For example, more rapid excretion of antibiotics may result in sub therapeutic levels, treatment failure or the selection of resistant micro-organisms. These complications in turn could significantly impact on morbidity and mortality associated with the patients ICU stay. This study will investigate this phenomenon in a population considered “at risk”, and define the role of commonly employed therapeutic inventions in promoting augmented clearances. This research will lead to further prospective work on tailoring dosage regimens in patients admitted to the ICU.

Interventions

a) Eight Hour Creatinine Clearance measures b) Collection of Demographic Data and Illness Severity Scores c) Collection of Haemodynamic variables d) Record of ICU and Hospital Outcome Data will be collected on a daily basis during the entire stay in the intensive care unit (ICU).

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Any patient requiring admission to the ICU with: a) Expected length of stay (LOS) > 24hours b) Normal renal function (admission serum creatinine < 120 umol/L)

Exclusion criteria

1)Absence of invasive haemodynamic monitoring as a part of routine management 2) Absence of an indwelling urinary catheter (IDC) as a part of routine management 3) Evidence of renal impairment 4) 'At Risk' of acute kidney injury (AKI) (> 1.5 fold increase in Serum Creatinine from baseline or urine output (UO) < 0.5ml/kg/hr for > 6hrs prior to enrolment 5) Age < 18years 6) Pregnancy 7) Lack of informed consent 8) Rhabdomyolysis is suspected clinically or serum creatinine kinase > 5000 9) Clinician considers the patient is unsuitable for enrolment

Outcome results