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Charco Roca, R. Peyró García, A. Ortega Cerrato" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L.M." "apellidos" => "Charco Roca" "email" => array:1 [ 0 => "luisacharco@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Peyró García" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Ortega Cerrato" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hiperfiltración glomerular en el paciente crítico" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">During perioperative management and in the Intensive Care Unit (ICU), anaesthesiologists follow the guidelines for renally excreted drugs in patients with varying degrees of kidney failure in order to avoid possible toxicities.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years, an increasing number of publications have appeared referring to the phenomenon of enhanced renal clearance or glomerular hyperfiltration (GHF). GHF is detected by creatinine clearance in urine (CrCl), and the cut-off point varies from 120 to 175<span class="elsevierStyleHsp" style=""></span>mL/min/1.73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>, depending on the study consulted. The absence of a unified definition of GHF prevents us from accurately determining the true prevalence of this phenomenon in the ICU<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. Because of these limitations, various reports have estimated the incidence of GHF in ICUs to be anything from 14% to 80%, showing the importance of this clinical condition.</p><p id="par0015" class="elsevierStylePara elsevierViewall">GHF can occur in several different pathologies, although it can also be a physiological consequence (pregnancy and a protein-rich diet). Although the pathophysiology of GHF in the ICU is unclear, critically ill patients are exposed to factors that can increase the likelihood of developing GHF, such as the use of intravenous fluids, vasopressors and inotropics. The onset of this phenomenon appears to coincide with an acute insult to the body and a massive release of cytokines<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The glomerular filtration (GFR) is the first stage in the elimination of drugs through the kidneys, and has traditionally been used as a measure of renal function for dose adjustment. In the case of HGF, enhanced drug clearance will lead to a shorter half-life, lower maximum drug concentration (C<span class="elsevierStyleInf">max</span>) and a smaller area under the concentration curve (AUC). We use renally excreted drugs (beta-lactams, aminoglycosides, vancomycin and levetiracetam) on a daily basis, and treating patients with subtherapeutic concentrations leads to therapeutic failure, increases medical costs, promotes resistance, and can even increase mortality<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>. Pharmacokinetic modifications can be particularly important in antibiotics, since therapeutic success in septic patients depends on early recognition of the infection and prompt start of empirical antibiotic therapy at appropriate doses.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Despite the importance of this, some studies estimate dose increases on the basis of Monte Carlo simulation models, but we found no validated recommendations for dose adjustments in HGF in general or for different degrees of severity of HGF.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Therapeutic drug monitoring has been shown to improve clinical outcomes, minimise toxicity, and maximise therapeutic effectiveness. This method, usually used in drugs with a narrow therapeutic margin or with dose-dependent adverse effects, can also allow prescribers to individualise treatment. Since it is almost impossible to measure the drug concentration at the site of action, the plasma concentration of a drug is thought to be related to its pharmacological effect. This type of monitoring should ideally be performed in patients with HGF, but in Spain it is not yet available for all drugs. β-lactam antibiotics, for example, are not considered candidates for therapeutic drug monitoring since they do not have a narrow therapeutic margin, and most of the adverse events are not dose-dependent.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Predictive tools, such as the ARC or ARCTIC Score<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>, can be used to identify patients at risk of HGF and take appropriate measures (calculating CrCl, switching to a more aggressive antibiotic regimen or dosing strategy, etc.). CrCl determination, however, is widely available and used in clinical practice to determine glomerular filtration, and it can also be performed at short sampling intervals<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Further studies are required to define the prevalence and importance of HGF in critically ill patients and various similar subpopulations (multiple trauma, sepsis, postoperative). It is still unclear whether this phenomenon is a predictor of nephropathy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study did not receive any financial support.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Charco Roca LM, Peyró García R, Ortega Cerrato A. Hiperfiltración glomerular en el paciente crítico. Rev Esp Anestesiol Reanim. 2021;68:545–546.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Augmented Renal Clearance in the Critically Ill: How to Assess Kidney Function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Veerle Grootaert" 1 => "Ludo Willems" 2 => "Yves Debaveye" 3 => "Geert Meyfroidt" 4 => "Isabel Spriet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1345/aph.1Q708" "Revista" => array:7 [ "tituloSerie" => "Ann Pharmacother" "fecha" => "2012" "volumen" => "46" "numero" => "7-8" "paginaInicial" => "952" "paginaFinal" => "959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22693271" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determining the mechanisms underlying augmented renal drug clearance in the critically ill: Use of exogenous marker compounds" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.A. 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AliOsman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/TA.0000000000001387" "Revista" => array:6 [ "tituloSerie" => "J Trauma Acute Care Surg" "fecha" => "2017" "volumen" => "82" "paginaInicial" => "665" "paginaFinal" => "671" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28129261" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Replacement of 24-h creatinine clearance by 2-h creatinine clearance in intensive care unit patients: a single-center study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.E. Herrera-Gutiérrez" 1 => "G. Seller-Pérez" 2 => "E. Banderas-Bravo" 3 => "J. Muñoz-Bono" 4 => "M. Lebrón-Gallardo" 5 => "J.F. 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Vol. 68. Issue 9.
Pages 545-546 (November 2021)
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Vol. 68. Issue 9.
Pages 545-546 (November 2021)
Letter to the Director
Glomerular hyperfiltration in critically ill patients
Hiperfiltración glomerular en el paciente crítico
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L.M. Charco Roca
, R. Peyró García, A. Ortega Cerrato
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Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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