Traumatic brain injury (TBI) is a significant public health concern that affects 1.7 million Americans each year, with estimated treatment costs totaling $76.5 billion annually in the United States alone. These costs may be even higher among TBI patients with comorbid conditions that can complicate treatment and recovery. For example, augmented renal clearance (ARC), a condition in which kidney responses are elevated, is common among neurocritical care patients. Heightened kidney responses can complicate care management as it eliminates therapeutic drugs from the body faster than necessary for an effective dose. Detecting ARC is therefore crucial to monitor the treatment process of TBI patients.
The reported prevalence of ARC in TBI patients ranges from 50 to 100 percent in various previous studies—variations of which are likely attributed to a failure to account for comorbiddisorders. To attain a more accurate understanding of ARC prevalence, a team of researchers conducted a study that identified the incidence, timing of development, and predictors of ARC in people with TBI.
The researchers measured how quickly and efficiently the kidneys processed and eliminated creatinine in 61 adult TBI patients. The results indicated that 82% of patients had elevated creatinine clearance for at least one day, indicating the presence of ARC. The onset of ARC usually occurred quickly after injury and was not related to the severity of head trauma. Younger patients and those with multiple traumatic injuries were more likely to develop ARC, suggesting that they may require more rigorous therapeutic actions.
Clinicians must be attentive to the dosage adjustment of renally eliminated drugs for these patient populations, particularly in the early phases of TBI treatment. Future clinical research may include investigating the mechanisms of ARC in TBI patients and patient outcomes in the weeks and months following TBI hospital visits.
Campassi M, Repetto F, Litardo D, et al. Incidence and determinants of augmented renal clearance in traumatic brain injury: A prospective observational study. Journal of Critical Care. (August 2022).