J Neurocrit Care.  2022 Dec;15(2):96-103. 10.18700/jnc.220061.

Prevalence and prediction of augmented renal clearance in the neurocritical care population

  • 1UK HealthCare Pharmacy Services and Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY, USA
  • 2Department of Pharmacy Services, University of California, Davis and University of California San Francisco School of Pharmacy, Sacramento, CA, USA


Augmented renal clearance (ARC; creatinine clearance [CrCl] >130 mL/min/1.73 m2) is prevalent in patients with neurological injuries and may influence their exposure to important pharmacological therapies. Little is known about the relationship between estimated and measured CrCl in this population.
This single-center, prospective, observational cohort study aimed to describe the association between ARC and estimated CrCl and neurological outcomes in a broad neurocritical care population. Prospective patient screening criteria included adults aged 18–85 years, with critical illness due to neurologic causes (such as ischemic stroke or subarachnoid hemorrhage) and lack of renal dysfunction on admission. Patients who had at least one urine CrCl measurement performed within the first 7 days of hospitalization were included. Two cohorts were evaluated: those with ARC and those without ARC.
Fifty-seven patients were included, of whom 49 (86%) exhibited ARC. Subjects with ARC were more likely to be male and had a significantly higher median measured CrCl (201.7 mL/min/1.73 m2) than those without ARC (109.8 mL/min/1.73 m2). The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score displayed the strongest association (vs. CrCl equations) with ARC development (area under the receiver operating characteristic curve, 0.648).
The prevalence of ARC in the present study of a broad neurocritical care population appeared to be high (86%). The ARCTIC score had higher sensitivity and specificity for diagnosing ARC than the common serum creatinine-based estimation.


Augmented renal clearance; Outcomes; Subarachnoid hemorrhage; Pharmacokinetics; Creatinine clearance; Aneurysm; Neurocritical care; Traumatic brain injury; Stroke


  • Fig. 1. Creatinine clearance calculations. CrCl, creatinine clearance; SCr, serum creatinine (mg/dl); BSA, body surface area (m2).

  • Fig. 2. Estimated versus measured creatinine clearance (CrCl) by disease state. Comparison of creatinine clearance values (estimated and measured) by disease state. This graph depicts the creatinine clearance values of all patients with or without augmented renal clearance. ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage; TBI, traumatic brain injury; AIS, acute ischemic stroke. P>0.05 for all comparisons between estimated and measured CrCl.

  • Fig. 3. Receiver operating characteristic (ROC) curves of various creatinine clearance equations (≥130 mL/min/m2) and Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score (≥6) (P-value for comparison, 0.74). MDRD, Modification of Diet in Renal Disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration.


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