#50: Vancomycin Doses and Trough Concentrations in Pediatric Patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S20
Author(s):  
Medalit Luna Vilchez ◽  
César Ugarte Gil ◽  
Diana Portillo Alvarez ◽  
Julio Maquera Afaray ◽  
Blanca Salazar Mesones ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Pediatric Patients ◽  
Multinomial Logistic Regression ◽  
Adult Population ◽  
Relative Risk Ratio ◽  
Serum Trough ◽  
Trough Concentrations ◽  
Trough Levels

Abstract Background Vancomycin serum trough concentrations are monitored to reduce nephrotoxicity and optimize therapeutic efficacy. Vancomycin pharmacokinetics and trough levels used in pediatric patients are extrapolated from the adult population. The pediatric dosing strategies are empirical and there is limited evidence to suggest that these doses result in the recommended steady-state trough concentrations. The objective of the study was to determine the association between vancomycin dosing regimens and trough concentrations levels of 10 to 20 μg/mL in pediatric patients with complicated infections. Methods Retrospective cohort, 505 trough vancomycin serum concentrations of patients of 1 month to 18 years from hospital wards and the Intensive Care Unit of the Instituto Nacional de Salud del Niño San Borja during December 2015 to April 2019. It included only the first vancomycin trough level measured 30 minutes before the fourth doses and serum trough concentrations of 10 to 20 μg/mL were considered as therapeutic levels. A multinomial logistic regression model to estimate the relative risk ratio (RRR) with a 95% confidence interval was used, the comparator group was therapeutic vancomycin levels and it was adjusted by glomerular filtration rate, age group, hospital room, dose interval, and weight. Results Five hundred and five vancomycin dosages were analyzed. Infants and children were 43.12% and 39.22%, respectively, 45.17% were women. 56.77% had a high glomerular filtration rate and only 28.02% of the patients obtained therapeutic trough levels of vancomycin. The RRR of having sub-therapeutic levels in patients with low glomerular filtration rates compared with normal filtration rates was 0.31 (P = 0.049) and the RRR of having sub-therapeutic levels in patients from 2 to 12 years compared with patients under 2 years old was 2.38 (P = 0.007). There was no difference in having therapeutic levels using doses equal or greater than 60 mg/kg/day vs. less than 40 mg/kg/day comparing sub-therapeutic levels (P = 0.655) and supratherapeutic levels (P = 0.264). Conclusions The empirical vancomycin regimens used in pediatric patients did not reach the recommended therapeutic trough levels of 10 to 20 μg/mL. Patients of 2 to 12 years and low glomerular filtration rates were associated to have sub-therapeutic trough levels.

scholarly journals Estimated glomerular filtration rate in patients overdosed with gentamicin

2020 ◽  
Vol 44 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Tomáš Šálek ◽  
Martin Vodička ◽  
Tomáš Gabrhelík
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Elevated Serum ◽  
Serum Trough ◽  
Gentamicin Concentration ◽  
Age Range ◽  
Trough Levels

Abstract Background The aim of this study was to compare the estimated glomerular filtration rate (eGFR) from serum creatinine (eGFRcrea) and cystatin C (eGFRcys) in patients with elevated serum trough levels of gentamicin before the next planned dose during treatment in the intensive care unit (ICU). Methods This was a retrospective observational study. Patients who stayed in an ICU, received a once-daily dose of gentamicin, and who had results from all serum gentamicin trough levels, eGFRcrea and eGFRcys analyses were included in the study. Overdosed patients were defined as those with serum gentamicin trough levels above 1 mg/L before the next dose. Gentamicin was measured by a particle-enhanced turbidimetric immunoassay (PETIA). Creatinine and cystatin C were measured by standardized methods. Results The median age (range) was lower in all patients with gentamicin concentration measurements than in overdosed patients (67 [19–96] vs. 75 [48–99] years, respectively; p < 0.0001). The median interquartile range (IQR) of the eGFRcrea was higher than that of the eGFRcys in overdosed patients (60 [44–79] mL/min/1.73 m2 vs. 41 [29–58] mL/min/1.73 m2, respectively; p < 0.0001). The median IQR of the eGFRcrea was higher than that of the eGFRcys in controls (87 [78–98] mL/min/1.73 m2 vs. 66 [54–93] mL/min/1.73 m2, respectively; p < 0.0001). Conclusions Overdosed patients had both a lower eGFRcrea and eGFRcys than controls. Elderly patients are the most commonly overdosed patients. We recommend measuring cystatin C and calculating the eGFRcys and combined equation (eGFRcrea + cys) in ICU patients over 65 years of age, which would enable improved gentamicin dosage adjustments.

Glomerular Filtration Rate Equations Do Not Accurately Predict Vancomycin Trough Concentrations in Pediatric Patients

2014 ◽  
Vol 48 (6) ◽  
pp. 691-696 ◽  
Author(s):  
Elizabeth L. Alford ◽  
Rebecca F. Chhim ◽  
Catherine M. Crill ◽  
M. Colleen Hastings ◽  
Bettina H. Ault ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Pediatric Patients ◽  
Rate Equations ◽  
Vancomycin Trough ◽  
Trough Concentrations

scholarly journals Estimation of GFR in Patients With Cystic Fibrosis: A Cross-Sectional Study

2020 ◽  
Vol 7 ◽  
pp. 205435811989931 ◽  
Author(s):  
Andrea Wallace ◽  
April Price ◽  
Erin Fleischer ◽  
Michael Khoury ◽  
Guido Filler
Keyword(s):  
Cystic Fibrosis ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Correlation Coefficient ◽  
Filtration Rate ◽  
Pediatric Patients ◽  
Cross Sectional Study ◽  
Infectious Complications ◽  
Schwartz Formula ◽  
Cross Sectional

Background: Patients with cystic fibrosis (CF) have frequent infectious complications requiring nephrotoxic medications, necessitating monitoring of renal function. Although adult studies have suggested that cystatin C (CysC)-based estimated glomerular filtration rate (eGFR) may be preferable due to reduced muscle mass of patients with CF, pediatric patients remain understudied. Objective: Our objective was to determine which eGFR formula is best for estimating glomerular filtration rate (GFR) in pediatric patients with CF. Methods: A total of 17 patients with CF treated with nephrotoxic antibiotics were recruited from the Children’s Hospital at London Health Sciences Centre, London, Ontario, Canada. 99Tc DTPA GFR (measured GFR [mGFR]) was measured with 4-point measurements starting at 120 minutes using a 2-compartmental model with Brøchner-Mortensen correction, with simultaneous measurement of creatinine, urea, and CysC. The eGFR was calculated using 16 known equations based on creatinine, urea, CysC, or combinations of these. Primary outcome measures were correlation with mGFR, and agreement within 10% for various eGFR equations. Results: Mean mGFR was 136 ± 21 mL/min/1.73 m2. Mean creatinine, CysC, and urea were 38 ± 10 μmol/L, 0.72 ± 0.08 mg/L, and 3.9 ± 1.4 mmol/L, respectively. The 2014 Grubb CysC eGFR had the best correlation coefficient ( r = 0.75, P = .0004); however, only 35% were within 10%. The new Schwartz formula with creatinine and urea had the best agreement within 10%, but a relatively low correlation coefficient ( r = 0.63, P = .0065, 64% within 10%). Conclusions: Our study suggests that none of the eGFR formulae work well in this small cohort of pediatric patients with CF with preserved body composition, possibly due to inflammation causing false elevations of CysC. Based on the small numbers, we cannot conclude which eGFR formula is best.

scholarly journals Glomerular Filtration Rate Estimation Formulas for Pediatric and Neonatal Use

2018 ◽  
Vol 23 (6) ◽  
pp. 424-431 ◽  
Author(s):  
Edit Muhari-Stark ◽  
Gilbert J. Burckart
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Pediatric Patients ◽  
Drug Clearance ◽  
Estimation Methods ◽  
Anthropometric Measures ◽  
Renal Biomarker ◽  
Glomerular Filtration Rate Estimation ◽  
Neonatal Population

Renal function assessment is of the utmost importance in predicting drug clearance and in ensuring safe and effective drug therapy in neonates. The challenges to making this prediction relate not only to the extreme vulnerability and rapid maturation of this pediatric subgroup but also to the choice of renal biomarker, covariates, and glomerular filtration rate (GFR) estimating formula. In order to avoid burdensome administration of exogenous markers and/or urine collection in vulnerable pediatric patients, estimation of GFR utilizing endogenous markers has become a useful tool in clinical practice. Several estimation methods have been developed over recent decades, exploiting various endogenous biomarkers (serum creatinine, cystatin C, blood urea nitrogen) and anthropometric measures (body length/height, weight, muscle mass). This article reviews pediatric GFR estimation methods with a focus on their suitability for use in the neonatal population.

scholarly journals Associations of Serum Lipids and Lipoproteins with the Estimated Glomerular Filtration Rate in the Adult Chinese Population: A Cross-sectional Study

2020 ◽  
Author(s):  
Xiaomu Kong ◽  
Zhaojun Yang ◽  
Bo Zhang ◽  
Liping Yu ◽  
Haiqing Zhu ◽  
...  
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Chinese Population ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Adult Population ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Effective Control ◽  
Lipids And Lipoproteins

Abstract Background: Dyslipidemia has a critical impact on renal dysfunction, but the exact types of lipids and lipoproteins that influence the estimated glomerular filtration rate (eGFR) are under investigation. Observations from an adult Chinese population ≥20 years old are lacking. The present study is to investigate the associations of total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C) with eGFR, and the risks for a mildly and a moderately/severely reduced eGFR. Methods: A total of 16,206 participants from a national representative adult population (20 years of age or older) in China were included. All calculations were weighted based on the Chinese population data and the sampling scheme. Results: Upon stratifying the population based on lipids or lipoprotein categories, we observed a significantly lower mean eGFR as well as a higher estimated prevalence of impaired eGFR among Chinese adults with TG levels in the ranges of 1.7 mmol/L≤ TG <2.3 mmol/L [mean eGFR: 110.99 mL/min per 1.73 m 2 , P =0.0000; prevalence of mildly eGFR impairment: 30.92%, P =0.0000; prevalence of moderately/severely eGFR impairment: 2.01%, P =0.1842] and ≥2.3 mmol/L [111.62 mL/min per 1.73 m 2 , P =0.0000; 27.92%, P =0.0000; 2.81%, P =0.0174], compared to those among individuals with normal TG [122.03 mL/min per 1.73 m 2 ; 19.96%; 1.20%]. Also, a higher prevalence of mildly impaired eGFR was observed with 3.4 mmol/L≤ LDL-C <4.1 mmol/L (27.93%) compared with LDL-C <3.4 mmol/L (22.61%, P =0.0092). An elevated TG was proven to be an independent risk factor for decreased eGFR [β(SE) -0.0238(0.0039), P =0.0000], and each per mmol/L increase in TG was associated with the 1.19-fold and 1.31-fold increased risks for mildly impaired eGFR and moderately/severely impaired eGFR, respectively ( P =0.0000, 0.0001). A decreased HDL-C also showed a negative contribution to eGFR [-0.0883(0.0176), P =0.0000]. In contrast, increased TC was associated with increased eGFR [0.0314(0.0060), P =0.0000] and a reduction in the risk for mildly impaired eGFR by 0.91-fold ( P =0.0302). Increased LDL-C also contributed to an elevated eGFR [0.0251(0.0070), P =0.0004]. Conclusion: A decreased eGFR could be attributed independently to an elevated TG or reduced HDL-C. It emphasizes the importance of effective control of TG and HDL-C for preserving eGFR.

Comparison of creatinine and cystatin C for estimation of glomerular filtration rate in pediatric patients after Fontan operation

2019 ◽  
Vol 14 (5) ◽  
pp. 760-764 ◽  
Author(s):  
Danielle Kirelik ◽  
Mark Fisher ◽  
Michael DiMaria ◽  
Danielle E. Soranno ◽  
Katja M. Gist
Keyword(s):  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Pediatric Patients ◽  
Fontan Operation
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