Impact of Augmented Renal Clearance on Infection Treatment Outcomes among Critically Ill Patients: A Systematic Review and Meta-Analysis

Background: Augmented renal clearance (ARC) is a medical phenomenon defined as a creatinine clearance of ≥130 mL/min. The literature that discusses the impact of ARC on clinical outcomes is inconsistent. The aim of this study was to assess whether ARC is associated with non-attainment of target antibiotic concentrations or treatment failure. Materials and Methods: We searched PubMed and Scopus databases for articles published on the impact of ARC on treatment failure or attainment of target antibiotic concentrations up until April 30, 2025. Nine studies met the inclusion criteria and were included. We conducted subgroup analyses based on the most common type of infection, the most administered antibiotic, and the dosing modality of broad-spectrum β -lactam antibiotics. The meta-analysis was performed using the random effect model. Results: None of the included studies were of low quality, and hence, none were excluded. Though the assessment of the publication bias was limited by the small number of the included studies, testing did not show significant asymmetry. ARC was significantly associated with a lack of attainment of target antibiotic concentrations, while the treatment failure rate was similar among ARC and no-ARC groups with significant heterogeneity. In the subgroup analyses, non-attainment of target concentrations among ARC patients was significantly associated with sepsis and piperacillin/tazobactam. Besides, treatment failure among ARC patients was significantly associated with respiratory infections and administering broad-spectrum β -lactam antibiotics via continuous infusion (CI). Conclusion: In the setting of ARC, higher doses of β -lactam antibiotics would enhance PK/PD exposure and may lead to optimized clinical outcomes.