Impact of total body weight on rate of acute kidney injury in patients treated with piperacillin–tazobactam and vancomycin

Abstract Purpose Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin–tazobactam and vancomycin are reported. Methods A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science’s Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded. Results A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28–1.66]). Conclusion Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin–tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.

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Vancomycin Removal during High-Volume Peritoneal Dialysis in Acute Kidney Injury Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00092 ◽

2019 ◽

Vol 39 (2) ◽

pp. 183-187 ◽

Cited By ~ 1

Author(s):

Daniela Ponce ◽

Welder Zamoner ◽

Fernanda Moreira Freitas ◽

André Balbi ◽

Linda Awdishu

Keyword(s):

Acute Kidney Injury ◽

Body Weight ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

High Volume ◽

Total Body Weight ◽

Empirical Treatment ◽

Total Body

Studies on vancomycin pharmacokinetics in acute kidney injury (AKI) patients on high-volume peritoneal dialysis (HVPD) are lacking. We studied the pharmacokinetics of intravenous (IV) vancomycin in AKI patients treated by HVPD who received a prescribed single IV dose of vancomycin (15 - 20 mg/kg total body weight) to determine the extent of vancomycin removal and to establish vancomycin dosing guidelines for the empirical treatment of AKI patients receiving HVPD. The application of 18 mg/kg vancomycin every 48 - 72 hours in AKI patients undergoing HVPD was required to maintain therapeutic concentrations.

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Impact of total body weight on acute kidney injury in patients with gram-negative bacteremia

Expert Review of Clinical Pharmacology ◽

10.1080/17512433.2018.1471984 ◽

2018 ◽

Vol 11 (6) ◽

pp. 651-654 ◽

Cited By ~ 2

Author(s):

Ronald G. Hall ◽

Eunice Yoo ◽

Andrew Faust ◽

Terri Smith ◽

Edward Goodman ◽

...

Keyword(s):

Acute Kidney Injury ◽

Body Weight ◽

Kidney Injury ◽

Total Body Weight ◽

Gram Negative ◽

Gram Negative Bacteremia ◽

Total Body

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Comparison of Static and Dynamic Baseline Creatinine Surrogates for Defining Acute Kidney Injury

Nephron ◽

10.1159/000516953 ◽

2021 ◽

pp. 1-11

Author(s):

David G. Warnock ◽

Javier A. Neyra ◽

Etienne Macedo ◽

Ayme D. Miles ◽

Ravindra L. Mehta ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Day Length ◽

University Of Alabama ◽

Inpatient Mortality ◽

Baseline Serum ◽

Net Reclassification Improvement ◽

Baseline Creatinine ◽

The University ◽

Final Cohort

Background: “Dynamic” baseline serum creatinine (sCr), based on a rolling 48-h window, and a static baseline sCr (previous outpatient sCr) were used to define acute kidney injury (AKI). Methods: Retrospective cohort study of adult admissions to the University of Alabama (UAB) Health System hospitals for years 2016–2018. Included admissions had >1- and <180-day length of stay, >2 inpatient sCr measurements, and an averaged estimated glomerular filtration rate >15 mL/min/1.73 m2. The final cohort of 62,380 patients included 100,570 admissions, 3,509 inpatient deaths, and 1,916 admissions with inpatient dialysis. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria and a static or dynamic baseline sCr. Discrimination was evaluated with area under receiver operator curves (AUC), logistic regression, and net reclassification improvement (NRI). Results: Preadmission outpatient “static” sCr values were available for 43,433 admissions. The lowest sCr value during a rolling 48-h window before each inpatient sCr defined a “dynamic” baseline sCr. Using point-wise comparisons, the dynamic baseline sCr performed better than static baseline sCr for inpatient mortality (AUC [0.819 vs. 0.741; p < 0.001] and NRI ≥0.306 [p < 0.001]) and inpatient dialysis (AUC [0.903 vs. 0.864; p < 0.001] and NRI ≥0.317 [p < 0.001]). Conclusions: The dynamic baseline sCr is available without reference to preadmission sCr values and avoids confounding associated with missing outpatient sCr values. AKI defined with the dynamic baseline sCr significantly improved discrimination of risk for inpatient mortality and dialysis compared to static baseline sCr.

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Reactive Stepping Responses Mediated by Predictable Manual Waist-Pull Perturbations are Associated with Fall History in Older Adults

Journal Of Aging Research And Healthcare ◽

10.14302/issn.2474-7785.jarh-20-3461 ◽

2020 ◽

Vol 3 (1) ◽

pp. 39-47

Author(s):

Rachana Gangwani ◽

Tanvi Bhatt ◽

Richard Bohannon ◽

Louis DePasquale

Keyword(s):

Older Adults ◽

Body Weight ◽

Sagittal Plane ◽

Total Body Weight ◽

Median Number ◽

Timed Up And Go ◽

Healthy Older Adults ◽

Total Body ◽

Using Data ◽

Reactive Stepping

Background and Purpose The ability to respond effectively to perturbations is a key element of reactive postural control and is a crucial mediator of falls. Several studies exist in the literature that determine older adults’ responses to perturbations, however those studies typically involve procedures that lack objectivity or applicability outside a laboratory. A study involving waist-pull perturbations with a spring-scale (SS) is an exception. In that study, fall history was most accurately differentiated by a reactive stepping response to a perturbing force of 10% total body weight. Using data from that study, we retrospectively examined the association between fall history and the number of steps accompanying a SS perturbing force of 10% total body weight in older adults. For perspective, the association of fall history with Timed-Up-and-Go (TUG) and single limb stance (SLS) times was also determined. Methods Fifty-eight healthy older adults (mean age = 80.7 years) participated in the study. Their 2-year fall history (yes, no) was recorded. All participants underwent SS testing with one-pound incremental, horizontal sagittal plane manual waist-pull perturbations. The number of steps in response to perturbation with 10% total body weight was recorded; TUG and SLS tests were performed. Associations between variables were examined using Spearman (rank-biserial) correlations. Results The median number of steps for fallers was 5 in both anterior and posterior directions. For non-fallers, the median number of steps was 1 and 2 in the anterior and posterior directions, respectively. The significant correlations between fall status and number of steps were 0.772 and 0.813 for the anterior and posterior directions, respectively. Similarly, the significant correlations between fall status and balance tests were 0.722 and -0.456 for the TUG and the SLS, respectively. Conclusions The number of steps accompanying waist-pull perturbations with forces of 10% of body weight were highly explanatory of experiencing a fall during the preceding 2 years.

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Incidence of Acute Kidney Injury among Patients Treated with Piperacillin-Tazobactam or Meropenem in Combination with Vancomycin

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00264-18 ◽

2018 ◽

Vol 62 (7) ◽

Cited By ~ 17

Author(s):

W. Cliff Rutter ◽

David S. Burgess

Keyword(s):

Acute Kidney Injury ◽

Alternative Therapy ◽

Kidney Injury ◽

Limited Data ◽

Inclusion Criteria ◽

University Of Kentucky ◽

Empirical Coverage ◽

End Stage ◽

The University ◽

The Impact

ABSTRACT Acute kidney injury (AKI) increases during empirical antimicrobial therapy with the combination of piperacillin-tazobactam (TZP) and vancomycin (VAN) compared to the number of incidences with monotherapy or the combination of cefepime and VAN. Limited data regarding the impact of meropenem (MEM) combined with VAN exist. This study examined the AKI incidence among patients treated with MEM plus VAN (MEM+VAN) or TZP+VAN. Data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust from September 2007 through October 2015. Adults without previous renal disease who received MEM+VAN or TZP+VAN for at least 2 days were included. AKI was assessed using risk, injury, failure, loss, and end-stage (RIFLE) criteria. Inverse probability of treatment weighting was utilized to control for differences between groups. In total, 10,236 patients met inclusion criteria, with 9,898 receiving TZP+VAN and 338 receiving MEM+VAN. AKI occurred in 15.4% of MEM+VAN patients and in 27.4% of TZP+VAN patients ( P < 0.001). TZP+VAN was associated with increased AKI compared to the level with MEM+VAN (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.82 to 3.52), after controlling for confounders. Use of MEM+VAN should be considered an appropriate alternative therapy to TZP+VAN if nephrotoxicity is a major concern. The results of this study demonstrate that judicial use of TZP+VAN for empirical coverage of infection is needed.

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Lean body weight versus total body weight to calculate the iodinated contrast media volume in abdominal CT: a randomised controlled trial

Insights into Imaging ◽

10.1186/s13244-020-00920-4 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Moreno Zanardo ◽

Fabio Martino Doniselli ◽

Anastassia Esseridou ◽

Massimiliano Agrò ◽

Nicol Antonina Rita Panarisi ◽

...

Keyword(s):

Body Weight ◽

Contrast Media ◽

Controlled Trial ◽

Total Body Weight ◽

Lean Body Weight ◽

Iodinated Contrast Media ◽

Abdominal Ct ◽

Iodinated Contrast ◽

Significant Difference ◽

Total Body

Abstract Objectives Iodinated contrast media (ICM) could be more appropriately dosed on patient lean body weight (LBW) than on total body weight (TBW). Methods After Ethics Committee approval, trial registration NCT03384979, patients aged ≥ 18 years scheduled for multiphasic abdominal CT were randomised for ICM dose to LBW group (0.63 gI/kg of LBW) or TBW group (0.44 gI/kg of TBW). Abdominal 64-row CT was performed using 120 kVp, 100–200 mAs, rotation time 0.5 s, pitch 1, Iopamidol (370 mgI/mL), and flow rate 3 mL/s. Levene, Mann–Whitney U, and χ2 tests were used. The primary endpoint was liver contrast enhancement (LCE). Results Of 335 enrolled patients, 17 were screening failures; 44 dropped out after randomisation; 274 patients were analysed (133 LBW group, 141 TBW group). The median age of LBW group (66 years) was slightly lower than that of TBW group (70 years). Although the median ICM-injected volume was comparable between groups, its variability was larger in the former (interquartile range 27 mL versus 21 mL, p = 0.01). The same was for unenhanced liver density (IQR 10 versus 7 HU) (p = 0.02). Median LCE was 40 (35–46) HU in the LBW group and 40 (35–44) HU in the TBW group, without significant difference for median (p = 0.41) and variability (p = 0.23). Suboptimal LCE (< 40 HU) was found in 64/133 (48%) patients in the LBW group and 69/141 (49%) in the TBW group, but no examination needed repeating. Conclusions The calculation of the ICM volume to be administered for abdominal CT based on the LBW does not imply a more consistent LCE.

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A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfp159 ◽

2009 ◽

Vol 24 (9) ◽

pp. 2739-2744 ◽

Cited By ~ 136

Author(s):

S. M. Bagshaw ◽

S. Uchino ◽

D. Cruz ◽

R. Bellomo ◽

H. Morimatsu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Baseline Creatinine

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Increases in adipose and total body weight, but not in lean body mass, associated with subcutaneous administration of Sonic hedgehog-Ig fusion protein to mice

Drug Development Research ◽

10.1002/ddr.10115 ◽

2002 ◽

Vol 57 (3) ◽

pp. 107-114 ◽

Cited By ~ 5

Author(s):

Pauline L. Martin ◽

Joan Lane ◽

Louise Pouliot ◽

Malcolm Gains ◽

Rudolph Stejskal ◽

...

Keyword(s):

Body Weight ◽

Fusion Protein ◽

Lean Body Mass ◽

Body Mass ◽

Sonic Hedgehog ◽

Subcutaneous Administration ◽

Total Body Weight ◽

Total Body

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Effects of the teratogenic folic acid antagonist, 9-methyl pteroylglutamic acid, on hydroxyproline levels in fetal rat limbs

Development ◽

10.1242/dev.41.1.289 ◽

1977 ◽

Vol 41 (1) ◽

pp. 289-294

Author(s):

R. R. Schmidt ◽

K. P. Chepenik ◽

B. V. Paynton

Keyword(s):

Body Weight ◽

Folic Acid ◽

Total Body Weight ◽

Pregnant Rats ◽

Skeletal Malformations ◽

Fetal Rat ◽

Pteroylglutamic Acid ◽

Limb Malformations ◽

Total Body ◽

Rate Of Accumulation

Pregnant rats were subjected to either a folic-acid-deficient regimen that produces multiple congenital skeletal malformations, or a control folic-acid-supplemented regimen. Fetal limbs were extirpated on days 16 and 18 of gestation, pooled from each litter, homogenized, and aliquots set aside for hydroxyproline, protein and DNA determinations. We found that (1) the amount of protein recovered per treated limb was approximately half that of controls on both days, (2) the amount of protein recovered per treated or controlday-18 limb was twice that of a day-16 limb, (3) treated limbs constituted the same percentage of total body weight as in controls on day 16, but a smaller percentage than in controls on day 18, and (4) the concentration of hydroxyproline (μg/mg protein) was significantly less for treated limbs than for controls on day 18 of gestation. We noted also that: (1) lowest hydroxyproline concentrations were found in limbs from treated fetuses with gross limb malformations, (2) intermediate concentrations were found in limbs of treated fetuses not exhibiting gross limb malformations, and (3) highest concentrations were found in control limbs. We suggest that the treatment resulted in (1) a decreased rate of accumulation of protein in limbs prior to day 16, but not from day 16 to day 18, (2) a decreased rate of accumulation of some non-protein component(s) in treated limbs from day 16 to day 18, and (3) an altered collagen metabolism.

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Influence of β-Lactam Infusion Strategy on Acute Kidney Injury

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00871-17 ◽

2017 ◽

Vol 61 (10) ◽

Cited By ~ 10

Author(s):

Sarah E. Cotner ◽

W. Cliff Rutter ◽

Donna R. Burgess ◽

Katie L. Wallace ◽

Craig A. Martin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Intermittent Infusion ◽

Prolonged Infusion ◽

Infusion Group ◽

Academic Medical ◽

Baseline Creatinine ◽

End Stage

ABSTRACT Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%; P = 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.

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