Development of 8-h urine collections and an augmented renal clearance dosing program at an academic medical center

Ensuring appropriate dosing of medications is an essential practice of clinical pharmacists. Dose adjustments in the setting of decreased renal function are common but may also be warranted for patients with supraphysiologic or augmented renal clearance (ARC). Conventional estimates of creatinine clearance using only serum creatinine may not be accurate in the setting of ARC, thus a measured creatinine clearance using serum and urine creatinine measurements are preferred. We describe the development of an 8-h urine collection and ARC dosing program at a large academic medical center initiated by critical care and infectious disease pharmacists. Using a Plan-Do-Study-Act approach, we implemented and updated the 8-h collection program with the guidance of our clinical laboratories. Eight-hour urine collections are useful for patients with suspected ARC and for other scenarios where accurate dose adjustments are needed to minimize toxicity in the absence of therapeutic drug monitoring.