1259: Early vs. Late ß-Lactam Antibiotic Dose Adjustment in Patients With Sepsis and Acute Kidney Injury

The use of sustained low-efficiency dialysis (SLED) as a renal replacement modality has increased in critically ill patients with both acute kidney injury (AKI) and hemodynamic instability. Unfortunately, there is a paucity of data regarding the appropriate dosing of medications for patients undergoing SLED. Dose adjustment in SLED often requires interpretation of pharmacodynamics and pharmacokinetic factors and extrapolation based on dosing recommendations from other modes of renal replacement therapy (RRT). This review summarizes published trials of antimicrobial dose adjustment in SLED and discusses pharmacokinetic considerations specific to medication dosing in SLED. Preliminary recommendation is provided on selection of appropriate dosing for medications where published literature is unavailable.

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MO417NEPHROLOGIST INTERVENTION TO AVOID KIDNEY REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab083.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jonathan Chávez ◽

Pablo Maggiani-Aguilera ◽

Andres De la Torre-Quiroga ◽

Alejandro Martínez-Gallardo Gonzalez ◽

Ramón Medina-González ◽

...

Keyword(s):

Acute Kidney Injury ◽

Replacement Therapy ◽

Prospective Cohort ◽

Kidney Injury ◽

Primary Objective ◽

Early Interventions ◽

Kidney Replacement Therapy ◽

The Impact ◽

First Time ◽

Antibiotic Dose

Abstract Background and Aims Based on the pathophysiology of acute kidney injury (AKI) it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression and death. Method In a prospective cohort at Hospital Civil of Guadalajara, we followed-up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment and removal of hyperchloremic solutions) after propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3 and death (secondary objectives). Results From 2017 to 2020 we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (OR 0.58, 95% CI 0.48-0.70, p = <0.001) and AKI progression to stage 3 (OR 0.59, 95% CI 0.49-0.71, p = <0.001). Receiving vasopressors and KRT were associated with mortality, but neither of these interventions reduced these risks. Conclusion In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment was associated with a reduction in the risk of starting KRT and progression to AKI stage 3.

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Acute Kidney Injury Associated with Linagliptin

Case Reports in Endocrinology ◽

10.1155/2016/5695641 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Deepak K. Nandikanti ◽

Elvira O. Gosmanova ◽

Aidar R. Gosmanov

Keyword(s):

Diabetes Mellitus ◽

Acute Kidney Injury ◽

Dose Adjustment ◽

Kidney Injury ◽

Intravascular Volume ◽

Dpp Iv ◽

First Case ◽

Kidney Impairment ◽

Renal Hypoperfusion

Linagliptin is a dipeptidyl peptidase-IV (DPP-IV) inhibitor that is approved for the treatment of type 2 diabetes mellitus. About 5% of linagliptin is eliminated by the kidneys and no dose adjustment is recommended in kidney impairment. We report a first case of linagliptin-associated acute kidney injury (AKI) in a patient with preexisting chronic kidney disease (CKD). We hypothesize that AKI was due to renal hypoperfusion from linagliptin-induced natriuresis and intravascular volume contraction in the setting of concomitant lisinopril use, which is known to impair autoregulation and potentiate hypotension-induced AKI. It may be prudent to exert caution and closely monitor kidney function when initiating linagliptin in combination with ACE-inhibitors in CKD patients.

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Systematic Review and Meta-analysis of the Association of Acute Kidney Injury with the Concomitant Use of Vancomycin and Piperacillin-Tazobactam in Children

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01572-19 ◽

2019 ◽

Vol 63 (12) ◽

Cited By ~ 4

Author(s):

Markos Kalligeros ◽

Spyridon A. Karageorgos ◽

Fadi Shehadeh ◽

Ioannis M. Zacharioudakis ◽

Eleftherios Mylonakis

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Publication Bias ◽

Pediatric Population ◽

Meta Analysis ◽

Kidney Injury ◽

Beta Lactam ◽

Beta Lactam Antibiotic ◽

Increased Risk ◽

Lactam Antibiotic

ABSTRACT Concomitant use of vancomycin plus piperacillin-tazobactam (TZP) has been associated with increased risk of acute kidney injury (AKI) in hospitalized adults. In this systematic review and meta-analysis, we searched PubMed and EMBASE for pediatric studies examining this hypothesis, with reference to vancomycin monotherapy or in combination with another beta-lactam antibiotic. Of 1,381 nonduplicate studies, 10 met our inclusion criteria. We performed a random-effects meta-analysis, based on crude odds ratios (ORs), and we accounted for both quality of included studies and publication bias. In primary analysis, concomitant vancomycin and TZP use yielded a statistically significant association with the development of AKI. More specifically, children with AKI had higher odds of having been exposed to vancomycin plus TZP than to vancomycin monotherapy (OR, 8.15; 95% confidence interval [CI], 3.49 to 18.99) or to vancomycin plus any other beta-lactam antibiotic (OR, 3.48; 95% CI, 2.71 to 4.46). On the basis of the results of the Newcastle-Ottawa scale quality assessment, a secondary analysis that included only higher-quality studies (6 of 10 studies) again yielded higher odds of exposure to vancomycin plus TZP than to vancomycin plus another beta-lactam antibiotic (OR, 3.76; 95% CI, 2.56 to 5.51). Notably, even after controlling for possible publication bias, our results remained statistically significant (OR, 3.09; 95% CI, 2.30 to 4.14). In conclusion, the concomitant use of vancomycin and TZP could be associated with AKI development and the clinical significance of this potential association needs to be studied further in the pediatric population.

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1929. Risk of Acute Kidney Injury in Combat-Injured Patients Associated With Concomitant Vancomycin and Extended-Spectrum β-Lactam Antibiotic Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1585 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S555-S556

Author(s):

Joseph Yabes ◽

Laveta Stewart ◽

Faraz Shaikh ◽

Dan Z Lu ◽

Teresa Merritt ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Antibiotic Use ◽

Extended Spectrum ◽

Lactam Antibiotic ◽

Injured Patients

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1411: EARLY ANTIPSEUDOMONAL BETA-LACTAM RENAL DOSE ADJUSTMENT IN SEPSIS AND ACUTE KIDNEY INJURY

Critical Care Medicine ◽

10.1097/01.ccm.0000811968.90871.ca ◽

2021 ◽

Vol 50 (1) ◽

pp. 708-708

Author(s):

Benjamin August ◽

Nicholas Pauley ◽

Meagan Conrath ◽

Joseph Johnson ◽

Zachary Smith

Keyword(s):

Acute Kidney Injury ◽

Dose Adjustment ◽

Kidney Injury ◽

Beta Lactam

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A Comparison of Adjusted Versus Unadjusted Doses of Polymyxin B Based on Renal Function and Incidence of Acute Kidney Injury

Journal of Pharmacy Practice ◽

10.1177/0897190018798881 ◽

2018 ◽

Vol 33 (3) ◽

pp. 255-261 ◽

Cited By ~ 1

Author(s):

Vincent Peyko ◽

Henry Cohen

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Clinical Cure ◽

Dose Adjustment ◽

Primary Outcome ◽

Kidney Injury ◽

Polymyxin B ◽

Care Community ◽

Study Support ◽

Microbiological Cure

Purpose: To determine whether or not polymyxin B needs dose adjustments based on renal function by comparing the incidence of acute kidney injury (AKI) in patients whose polymyxin B doses were adjusted versus not adjusted according to renal function. Methods: This was a single-center, prospective study with a retrospective cohort taking place in an acute care community hospital. Forty-two patients treated with polymyxin B were evaluated between April 2012 and December 2015. The primary outcome was incidence of AKI at day 7 after initiation of polymyxin B therapy with secondary outcomes including microbiological cure, clinical cure, and 30-day mortality. Results: There was no difference in the incidence of AKI at day 7 in patients with polymyxin B doses adjusted according to renal function versus patients without polymyxin B dose adjustment (20.0% vs 18.2%; P = .882). There were no differences between groups in occurrence of microbiological cure, clinical cure, or 30-day mortality (27.8% vs 57.1%; P = .065, 70.0% vs 72.7%; P = .845, 40.0% vs 31.8%; P = .581, respectively). Conclusion: The results from this study support the use of polymyxin B without any dose adjustment in the setting of renal impairment.

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Efficacy and Safety of Cystatin C-Guided Renal Dose Adjustment of Cefepime Treatment in Hospitalized Patients with Pneumonia

Journal of Clinical Medicine ◽

10.3390/jcm9092803 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2803

Author(s):

Min-Chul Kim ◽

Seon Ok Kim ◽

Su-Hyun Kim ◽

Jung-ho Shin ◽

Seong-Ho Choi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clostridium Difficile ◽

Cystatin C ◽

Clostridium Difficile Infection ◽

Dose Adjustment ◽

Kidney Injury ◽

Clinical Impact ◽

Hospitalized Patients ◽

Efficacy And Safety ◽

Significant Difference

Cystatin C (CysC) may estimate renal function more accurately than serum creatinine (SCr). The clinical impact of renal dose adjustment of cefepime according to CysC rather than SCr has remained uncertain. We investigated the efficacy and safety of CysC-guided cefepime dosing compared with SCr-guided dosing in hospitalized patients with pneumonia. All adults hospitalized with pneumonia between July 2016 and December 2018 who used cefepime for at least 3 days were enrolled. Mortality, acute kidney injury (AKI), cefepime-induced encephalopathy (CIE), and Clostridium difficile infection were compared between the CysC-guided and SCr-guided groups. One hundred and ninety patients were divided into two groups: 129 and 61 received cefepime based on CysC and SCr, respectively. In-hospital mortality did not significantly differ between the groups (12% versus 31%; hazard ratio (HR) 0.74; 95% confidence interval (CI), 0.31–1.77; p = 0.50). CysC-guided cefepime dosing decreased the risk of AKI (13% versus 61%; HR 0.18; 95% CI, 0.07–0.44; p < 0.001) and CIE (2% versus 11%; HR 0.11; 95% CI, 0.03–0.47; p = 0.003) compared with SCr-guided dosing. There was no significant difference in the risk of Clostridium difficile infection. CysC-guided dosing of cefepime was associated with decreased risk of the cefepime-associated morbidities including AKI and CIE without increasing mortality among the hospitalized patients with pneumonia.

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