The Definition, Prevalence, and Risk Factors of Augmented Renal Clearance in Adult Patients on Antimicrobial Therapy: A Scoping Review.

Objective: Augmented renal clearance (ARC), defined as rapid drug clearance, can lead to subtherapeutic antimicrobial concentrations in specific patient populations. This scoping review aimed to synthesize current evidence on ARC in adult patients receiving antimicrobial treatment, focusing on its prevalence, risk factors, and influence on attaining therapeutic drug levels. It also identified gaps for future research and provided dosage recommendations.

Materials and methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Scoping Reviews (PRISMA-ScR) reporting guidelines. The titles, abstracts, and keywords of the studies indexed in Web of Science, PubMed, or Scopus between 2019 and 2023 were extensively analyzed for relevance to ARC and antimicrobial therapy. Non-English articles, reviews, and non-human studies were excluded. Data extracted included article type, study details, patient population, ARC definition, ARC prevalence, methods of renal function assessment, and study results.

Results: Of 492 articles identified, 47 met the inclusion criteria, covering a total of 6193 patients. ARC prevalence in the studies ranged from 3.3% to 100%. The Cockcroft-Gault equation was the most commonly used method for calculating creatinine clearance (66%). Risk factors for ARC were reported in 8.5% of the studies, and glycopeptides were the most frequently examined drug class (31.9%). In 26 (55.3%) studies, high doses or prolonged infusions were recommended to achieve therapeutic drug levels.

Conclusion: β-lactams and linezolid may require prolonged infusion or higher doses in ARC patients, while glycopeptides and aminoglycosides may also require higher doses. Further research is needed to clarify how ARC affects clinical outcomes and dosing strategies.