ReviewPediatric nephrology (Berlin, Germany)2020
Augmented renal clearance in pediatric intensive care: are we undertreating our sickest patients?
Review in Pediatric nephrology (Berlin, Germany), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it, 81 citations in OpenAlex.
- Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature.Clinical pharmacokinetics · 2020Pooled it
- Population Pharmacokinetic Modeling and Target Attainment of Cefepime in Critically Ill Pediatric Patients.Open forum infectious diseases · 2026Trial
- Predictors of augmented renal clearance based on iohexol plasma clearance in critically ill children.Pediatric nephrology (Berlin, Germany) · 2024Trial
- Augmented renal clearance: from pathophysiological mechanisms to clinical implications and research perspectives.Renal failure · 2026Review
- Advancing Pediatric Dose Scaling: Strategies, Modeling Approaches, and Clinical Applications.Pharmaceuticals (Basel, Switzerland) · 2026Review
- Achieving therapeutic antibiotic levels during intermittent dosing of meropenem and piperacillin-tazobactam in critically ill children: the ATACC study.Antimicrobial agents and chemotherapy · 2026Observational
- Amikacin pharmacokinetics, target attainment, and predictors in critically ill children: a retrospective cohort.European journal of pediatrics · 2026Article
- Accurate Estimation of Glomerular Filtration Rate in Critically Ill Infants and Children Using a Iohexol Population Pharmacokinetic Modeling Approach.Clinical pharmacokinetics · 2026Article
- β-Lactam dosing in critically ill children: predictors for target non-attainment.The Journal of antimicrobial chemotherapy · 2026Observational
- Low Target Attainment of Intravenous Cefuroxime in Critically Ill Term Neonates and Children: A Pooled Population Pharmacokinetics Study.Clinical pharmacokinetics · 2026Article
- The long walk to a short half-life: the discovery of augmented renal clearance and its impact on antibiotic dosing.The Journal of antimicrobial chemotherapy · 2025Review
- Piperacillin dosing in pediatric patients and augmented renal clearance: are current guidelines sufficient to achieve therapeutic concentration coverage?The Journal of antimicrobial chemotherapy · 2025Article
- Variability in Meropenem Distribution and Clearance in Children with Sepsis: Population-Based Pharmacokinetics with Assessment of Renal Biomarkers.Clinical pharmacokinetics · 2025Article
- Leveraging Clinical Data to Enhance the Performance Evaluation of Ceftriaxone Population Pharmacokinetic Models in Children.Clinical pharmacokinetics · 2025Article
- A Real-Life Study of Prolonged Meropenem Infusion in Neonates and Children Admitted to Intensive Care Units: Are Three Hours Long Enough?Journal of clinical medicine · 2025Article
- Evaluation of a Bayesian dosing calculator for vancomycin in pediatric patients with augmented renal clearance.Frontiers in pediatrics · 2025Article
- Dose optimization of cefazolin in South African children undergoing cardiac surgery with cardiopulmonary bypass.CPT: pharmacometrics & systems pharmacology · 2024Article
- Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference.Pediatric nephrology (Berlin, Germany) · 2024Article
- Article
- Population pharmacokinetics and dose optimization of ceftazidime in critically ill children.Frontiers in pharmacology · 2024Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Many critically ill patients display a supraphysiological renal function with enhanced renal perfusion and glomerular hyperfiltration. This phenomenon described as augmented renal clearance (ARC) may result in enhanced drug elimination through renal excretion mechanisms. Augmented renal clearance seems to be triggered by systemic inflammation and therapeutic interventions in intensive care. There is growing evidence that ARC is not restricted to the adult intensive care population, but is also prevalent in critically ill children. Augmented renal clearance is often overlooked due to the lack of reliable methods to assess renal function in critically ill children. Standard equations to calculate glomerular filtration rate (GFR) are developed for patients who have a steady-state creatinine production and a stable renal function. Those formulas are not reliable in critically ill patients with acutely changing GFR and tend to underestimate true GFR in patients with ARC. Tools for real-time, continuous, and non-invasive measurement of fluctuating GFR are most needed to identify changes in kidney function during critical illness and therapeutic interventions. Such devices are currently being validated and hold a strong potential to become the standard of practice. In the meantime, urinary creatinine clearance is considered the most reliable method to detect ARC in critically ill patients. Augmented renal clearance is clearly associated with subtherapeutic antimicrobial concentrations and subsequent therapeutic failure. This warrants the need for adjusted dosing regimens to optimize pharmacokinetic and pharmacodynamic target attainment. This review aims to summarize current knowledge on ARC in critically ill children, to give insight into its possible pathophysiological mechanism, to evaluate screening methods for ARC in the pediatric intensive care population, and to illustrate the effect of ARC on drug exposure, therapeutic efficacy, and clinical outcome.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.