Augmented renal clearance in non-critically ill abdominal and trauma surgery patients is an underestimated phenomenon: a point prevalence study.

Background: Augmented renal clearance refers to increased renal elimination of circulating solutes as compared with normal baseline and could lead to underexposure of frequently used renally eliminated antimicrobials. The primary objective was to assess the prevalence of augmented renal clearance in an adult non-critically ill surgery population. Besides, predictors for augmented renal clearance were investigated. A prospective observational single-center point prevalence study was conducted. Methods: The measured creatinine clearance based on an 8-hour urinary collection was used as primary method for determining kidney function. Augmented renal clearance was defined as measured creatinine clearance >= 130 ml/min/1.73m2. A Poisson regression model was applied to identify predictors for augmented renal clearance. Results: Augmented renal clearance prevalence was 30 and 35 % in 103 abdominal and 129 trauma surgery patients, respectively. Younger age (abdominal cohort: RR, 0.963 [95% CI, 0.949-0.978]; trauma cohort: RR, 0.971 [95% CI, 0.960-0.983]) and also for trauma surgery patients, male gender (RR, 1.808 [95% CI, 1.026-3.185]) were found to be independent predictors for augmented renal clearance. Conclusions: Augmented renal clearance is an underestimated phenomenon in adult noncritically ill surgery patients. Especially younger patients, and, in the subset of trauma surgery, males, are prone to exhibit augmented renal clearance. Since augmented renal clearance is a risk factor for lower antimicrobial exposure, the impact of augmented renal clearance in relation to antimicrobial underexposure should be investigated in this population. Level of evidence: This is a prospective epidemiological study with one negative criteria (heterogeneous population: trauma and abdominal surgery patients; elective and non-elective admissions). Therefore we determine the level of evidence as Level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

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