P446 - AUGMENTED RENAL CLEARANCE IN AN ADULT INTENSIVE CARE SETTING – PREVALENCE, RISK FACTORS AND IMPACT ON CLINICAL OUTCOMES

P446

AUGMENTED RENAL CLEARANCE IN AN ADULT INTENSIVE CARE SETTING – PREVALENCE, RISK FACTORS AND IMPACT ON CLINICAL OUTCOMES

V. Rewari^1,*, K. N¹, R. Ramachandran¹, S. Datta², B. R. Ray¹, A. Trikha³

¹Department of Anaesthesiology,Pain medicine and Critical care, ²Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India, ³Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center, Hershey,PA, United States

Rationale:  The primary objective of the study was to  identify the prevalence of Augmented renal clearance (ARC) in a mixed cohort of medical ,surgical and trauma patients in an adult intensive care setting . The secondary objectives were to  describe the correlation between eGFR formulas with measured 24 hours urinary CrCl, to identify risk factors associated with ARC and effect of ARC on ICU length of stay (LOS) and ICU survival.

Methods: A prospective observational study was conducted in 278 patients over a span of 2 years. Patients aged 18-80 years, receiving antibiotics, expected ICU stay > 24 hours were included.  ARC was defined as 24 hours urinary CrCl >130 mL/min/m².  eGFR was calculated as per MDRD4, CKD-EPI and CG equations. 

Results:  The median serum creatinine (mg/dL) level at admission was 0.6 (IQR: 0.5-0.8). The mean  eGFR by CG, MDRD4 and CKD-EPI formula were 156.26 ± 69.43, 153.82 ± 76.05 and 121.72 ± 22.75 mL/min/1.73m² respectively. The mean 24 hours creatinine clearance (mL/min/1.73m²) was 124.46 ± 79.78. The prevalence of ARC was 40.3%. The significant risk factors for ARC were younger age, male gender, height, APACHE II score, SOFA score, serum creatinine at admission, hypertension, administration of vasopressors, nephrotoxic antibiotics, diuretics, and fluid balance at 24 hours. After multivariate logistic regression analysis , the  predictors of ARC were SOFA score <5[OR 0.82 (0.70-0.96, p=0.015)] and eGFR  measured by CKD-EPI [OR 1.05 (1.03-1.07, p<0.001)]. Optimal cut-off for eGFR by CKD-EPI to define ARC was 126mg/dL.

Conclusion: The prevalence of ARC in our population was found to be 40.3%. The  predictors of ARC were SOFA score <5 and eGFR  as measured by CKD-EPI . The measurement of eGFR by CKD-EPI formula is a good estimate of ARC when a cut-off of 126mg/dL is applied.

Disclosure of Interest: V. Rewari Other: None, K. N Other: None, R. Ramachandran Other: None, S. Datta Other: None, B. Ray Other: None, A. Trikha Other: None