Boeykens, Nicky

De Cock, Pieter

De Paepe, Peter

Delanghe, Joris

Dhont, Evelyn

Leenknegt, Benjamin

Peperstraete, Harlinde

Roelandt, Karlien

Van Der Heggen, Tatjana

Vande Walle, Johan

English

Ghent University Academic Bibliography

Dosing renally cleared drugs in critically ill children: mind the trap of glomerular hyperfiltration !1.  BACKGROUND4. RESULTS5. CONCLUSIONContact information: pieter.decock@uzgent.be 3. METHODSDe Cock P1,2, Van Der Heggen T2,3, Dhont E4, Boeykens N1, Roelandt K2, Leenknegt B2 ,Peperstraete H5, Delanghe J6, Vande Walle J7, De Paepe P1,2• GHF is a common phenomenon in the pediatric ICU, especially in the youngest children and those not on vasopressor support. • We recommend using an age dependent definition of GHF, related to renal maturation processes.  • As GHF may lead to subtherapeutic treatment of renally eliminated drugs, early detection of patients at risk is of main importance. This study was a single center, prospective, observational study,conducted at the pediatric intensive care unit (PICU) and the cardiacsurgery intensive care unit (CSICU) of the Ghent University Hospital,Belgium. Patients between 1 month and 15 years of age with abladder catheter were enrolled. GFR was measured by means of acalculated 24 hours creatinine clearance (24h ClCr) during amaximum of 4 consecutive days. GHF was defined as a GFRexceeding normal values for age plus two standard deviations.Logistic regression analysis was used to identify covariates for GHF.The following variables with a clinical plausibility were entered inunivariate analysis: age, weight, length, body surface area (BSA),amount of IV fluids administered, and vasopressor support. Thosewith an a priori determined p value < 0.10 in univariate analysiswere entered in multivariate regression analysisGlomerular hyperfiltration (GHF), defined as an elevatedglomerular filtration rate (GFR), induces the enhanced eliminationof circulating solute by the kidneys. Recently, this phenomenonhas received increasing attention in critically ill adults. Theincidence in this setting is high, varying between 28-65%. Incritically ill children, data on the incidence of GHF are scarce.[1] Department of Pharmacy, Ghent University Hospital - [2] Heymans Institute of Pharmacology, Ghent University - [3] Department of Pediatrics, Ghent University Hospital - [4] Department of Pediatric Intensive Care, Ghent University Hospital - [5] Department of Cardiac Intensive Care, Ghent University Hospital - [6] Department of Laboratory Medicine, Ghent University Hospital - [7] Department of Pediatric Nephrology, Ghent University Hospital Data were collected from 65 patients (median age 1.7 years, IQR 3.0). On the first day following admission to the ICU, 80% of patients expressed GHF. In total, GHF was seen atleast once in 84.6% of patients. Smaller BSA, strongly correlated to younger age, and the absence of vasopressor support were found as independent associated factors withthe development of GHF (table 1).2. AIMPrimary objective: To investigate the incidence of GHF in critically ill children.  Secondary objective: To identify factors associated with the development of GHF.Fig 1. Age dependent normal GFR (pink) andlimit for GHF (blue)Fig 2. Creatinine clearance in patients with vs. without GHF. GHF patients had a median 24 hours creatinine clearance of 181.8 ml/min/1.73m² (IQR 75.0) on the first day, compared to 40.2 ml/min/1.73m² (IQR 78.9) in patients without GHF.n = 6576,9% 74,1% 68,8%Fig 3. Evolution of GHF during the study. The percentage of patients presenting with GHF slowly decreases during consecutive days following admission to the ICU. P<0.00180,0%n = 39n = 27n = 16Table 1. Variables associated with GHF (logistic regression, multivariate analysis)Smaller BSA and the absence of vasopressor support were independently associated with the development of GHF. OR = odds ratio, CI = confidence interval. Hosmer-Lemeshow (goodness-of-fit): χ² = 11.972, df = 8, P=0.152. Factor OR 95% CI P-valueBSA 0.078 0.019-0.319 < 0.001Vasopressor support 0.258 0.097-0.687 0.007

Dosing renally cleared drugs in critically ill children : mind the trap of glomerular hyperfiltration!

https://biblio.ugent.be/publication/8564526/file/8564701.pdf

Dosing renally cleared drugs in critically ill children : mind the trap of glomerular hyperfiltration!

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