Nicholas Nelson, BCPS, PharmD
University of Michigan Health System
Ann Arbor, MI
Disclosure information not submitted.
Denise Rhoney, PharmD, FCCP, FCCM, FNCS
Ron and Nancy McFarlane Distinguished Professor
University of North Carolina Eshelman School of Pharmacy
Plymouth, Michigan, United States
Disclosure information not submitted.
Title: A Rapid Review of Augmented Renal Clearance in Patients with COVID19
Introduction: Augmented renal clearance (ARC) has been characterized as supraphysiologic renal function defined by creatinine clearance (CrCl) greater than 130mL/min/1.73m2. ARC has traditionally been described in critically ill patients and has been recently reported in patients with COVID19. The aim of this rapid review was to collate and summarize published evidence of ARC in COVID19 and compare to other critically ill patients.
Methods: PubMed, Embase, and Scopus were searched using keywords focusing on ARC and COVID19. Reviews and non-English and non-human items were excluded. Screening utilized a two-phase, two-reviewer process and two authors resolved all conflicts. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. COVID19 studies were compared to recently published ARC review articles and meta-analyses.
Results: Four citations included COVID19 patients. All citations utilized a CrCl >130mL/min/1.73m2 to define ARC; 3 utilizing urine CrCl while one did not mention detection method. Each citation noted an ARC prevalence of 40%, similar to sepsis (40-56%) compared to 14-80% reported in other critically ill populations. One citation commented on risk factors including male and younger age, similar to other non-COVID populations, but also noted inflammatory markers (ferritin, CRP, D-dimer) correlating with ARC. Notably, COVID patients experience ARC much later (2-4 weeks) in their illness compared to other ICU populations (1-5 days). Importantly, ARC has been associated with subtherapeutic drug concentrations in COVID19 and non-COVID19 patients, and COVID19 patients with ARC have a significant increased incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) (44% vs 31%, 33% vs 10%; p=0.025, respectively).
Conclusions: While much attention has been paid to renal injury in COVID19, ARC is another important clinical phenomenon to consider, but there is a paucity of data in this population. It appears to manifest differently compared to other patient populations, occurring much later in a patient’s clinical course, and has been associated with negative clinical outcomes including DVT and PE. This new biomarker data from COVID19 ARC patients provides new avenues for other populations to further elucidate ARC mechanism and additional predictive methods.