Are Blacks at Higher Risk for Vancomycin-Related Acute Kidney Injury?

Background: Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race. Methods: Retrospective study of adult (3 ≥18 years) inpatients who were on vancomycin for 348 hours between January 2012 and December 2014. Data on demographics, comorbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected. Patients with a creatinine clearance <30 mL/min or undergoing dialysis were excluded. Results: We identified 1130 patients during the study period; 48.1% (544) were black. The overall incidence of AKI was 8.2% (10.1% blacks, 6.5% whites; P = .03). Independent predictors of AKI included black race ( P = .011); higher Charlson score ( P = .006); higher body mass index (BMI; P = .002); higher vancomycin trough level ( P < .0001); and sepsis/systemic inflammatory response syndrome (<.0001), pneumonia ( P = .001) or gastrointestinal/genitourinary ( P = .025) as the source of infection. Conclusion: The incidence of vancomycin-related AKI was higher in blacks, independent of other risk factors. Based on our study, vancomycin trough levels and renal function need to be closely monitored in blacks.

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Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

Journal of Pharmacy Practice ◽

10.1177/0897190019829652 ◽

2019 ◽

Vol 33 (6) ◽

pp. 749-753 ◽

Cited By ~ 2

Author(s):

William B. Hays ◽

Emma Tillman

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Young Adult ◽

Critically Ill ◽

Kidney Injury ◽

Adult Patients ◽

Adolescent And Young Adult ◽

Daily Dose ◽

Vancomycin Trough ◽

Trough Levels

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P = .006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P = .012) and concurrent vasopressor (55% vs 23%, P = .029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P = .021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

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Incidence and risk factors of vancomycin-associated acute kidney injury in a single center: Retrospective study

Journal of Clinical Nephrology ◽

10.29328/journal.jcn.1001067 ◽

2021 ◽

Vol 5 (1) ◽

pp. 010-016

Author(s):

Yalamarti Tanuja ◽

Zonoozi Shahrzad ◽

Adu Ntoso Kwabena ◽

Alborzi Pooneh

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

High Serum ◽

Hospitalized Patients ◽

Close Monitoring ◽

Iodinated Contrast ◽

Vancomycin Trough ◽

Serum Vancomycin ◽

Trough Levels

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI. Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

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Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

American Journal of Nephrology ◽

10.1159/000496484 ◽

2019 ◽

Vol 49 (2) ◽

pp. 133-142 ◽

Cited By ~ 3

Author(s):

Geeta Gyamlani ◽

Praveen K. Potukuchi ◽

Fridtjof Thomas ◽

Oguz Akbilgic ◽

Melissa Soohoo ◽

...

Keyword(s):

Acute Kidney Injury ◽

Estimated Glomerular Filtration Rate ◽

Trough Level ◽

Kidney Injury ◽

Serum Levels ◽

Glycopeptide Antibiotics ◽

Serum Trough ◽

Antibiotics Use ◽

Vancomycin Trough ◽

Serum Vancomycin

Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m2, we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1–1.2), 1.2 (1–1.4), and 1.4 (1.1–1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4–1.7), 1.9 (1.5–2.3), and 2.7 (2–3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

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Relationship of vancomycin trough levels with acute kidney injury risk: an exposure-toxicity meta-analysis v1 (protocols.io.bcctiswn)

protocols.io ◽

10.17504/protocols.io.bcctiswn ◽

2020 ◽

Author(s):

Ioannis Bellos ◽

Georgios Daskalakis ◽

Vasilios Pergialiotis

Keyword(s):

Acute Kidney Injury ◽

Injury Risk ◽

Meta Analysis ◽

Kidney Injury ◽

Vancomycin Trough ◽

Relationship Of ◽

Trough Levels

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Hospital-Acquired Acute Kidney Injury in Older Patients: Clinical Characteristics and Drug Analysis

Gerontology ◽

10.1159/000518938 ◽

2021 ◽

pp. 1-8

Author(s):

Wei Liu ◽

Xing-ji Lian ◽

Yuan-han Chen ◽

Yi-ping Zou ◽

Jie-shan Lin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Older Patients ◽

Clinical Characteristics ◽

Kidney Injury ◽

Hospital Outcomes ◽

Prior Use ◽

Nephrotoxic Drugs ◽

Medical Wards ◽

Hospital Acquired

Background: Information on older patients with hospital-acquired acute kidney injury (HA-AKI) and use of drugs is limited. Aim: This study aimed to assess the clinical characteristics, drug uses, and in-hospital outcomes of hospitalized older patients with HA-AKI. Methods: Patients aged ≥65 years who were hospitalized in medical wards were retrospectively analyzed. The study patients were divided into the HA-AKI and non-AKI groups based on the changes in serum creatinine. Disease incidence, risk factors, drug uses, and in-hospital outcomes were compared between the groups. Results: Of 26,710 older patients in medical wards, 4,491 (16.8%) developed HA-AKI. Older patients with HA-AKI had higher rates of multiple comorbidities and Charlson Comorbidity Index score than those without AKI (p < 0.001). In the HA-AKI group, the proportion of patients with prior use of drugs with possible nephrotoxicity was higher than that of patients with prior use of drugs with identified nephrotoxicity (p < 0.05). The proportions of patients with critical illness, use of nephrotoxic drugs, and the requirements of intensive care unit treatment, cardiopulmonary resuscitation, and dialysis as well as in-hospital mortality and hospitalization duration and costs were higher in the HA-AKI than the non-AKI group; these increased with HA-AKI severity (all p for trend <0.001). With the increase in the number of patients with continued use of drugs with possible nephrotoxicity after HA-AKI, the clinical outcomes showed a tendency to worsen (p < 0.001). Moreover, HA-AKI incidence (adjusted odds ratio [OR], 10.26; 95% confidence interval (CI), 8.27–12.74; p < 0.001), and nephrotoxic drugs exposure (adjusted OR, 1.76; 95% CI, 1.63–1.91; p < 0.001) had an association with an increased in-hospital mortality risk. Conclusion: AKI incidence was high among hospitalized older patients. Older patients with HA-AKI had worse in-hospital outcomes and higher resource utilization. Nephrotoxic drug exposure and HA-AKI incidence were associated with an increased in-hospital mortality risk.

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Vancomycin Trough Levels: Cause or Result of Acute Kidney Injury?

American Journal of Nephrology ◽

10.1159/000452430 ◽

2016 ◽

Vol 44 (6) ◽

pp. 454-455 ◽

Cited By ~ 1

Author(s):

William M. Bennett

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Vancomycin Trough ◽

Trough Levels

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Clinical characteristics and prognosis of postpartum acute kidney injury

Journal of International Medical Research ◽

10.1177/0300060520988388 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098838

Author(s):

Hong Shu ◽

Fang Nie

Keyword(s):

Acute Kidney Injury ◽

Clinical Characteristics ◽

Survival Rates ◽

Kidney Injury ◽

Renal Recovery ◽

Replacement Treatment ◽

Elevated Liver Enzymes ◽

Recovery Times ◽

Low Platelet Count ◽

Lost To Follow Up

Objective To investigate the clinical characteristics and prognoses of patients with postpartum acute kidney injury (PPAKI). Methods We retrospectively reviewed the clinical presentations, laboratory examinations, treatments, and outcomes of patients with PPAKI admitted to our hospital from January 2013 to December 2017. We then analyzed the clinical characteristics and prognoses of the mothers and their infants. Results Of 37 patients diagnosed with PPAKI, 26 (70.3%) received treatment in the intensive care unit, mainly for hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (28/37, 75.7%), pre-eclampsia (26/37, 70.3%), and postpartum hemorrhage (22/37, 59.5%). Twenty patients required renal replacement treatment (RRT), but renal recovery times were similar in the RRT and non-RRT groups. Renal function recovered completely in 30 patients (81.1%) and partially in one patient (2.7%), and was not re-examined in two patients (5.4%). Three patients (8.1%) were lost to follow-up. Only one patient (2.7%) remained dialysis-dependent, and no maternal deaths occurred. The preterm birth, low birth weight, and infant survival rates were 70.7% (29/41), 68.3% (28/41), and 78.0% (32/41), respectively. Conclusion RRT does not reduce renal recovery time compared with non-RRT. Overall, the prognoses of both mothers and their fetuses are good following treatment for PPAKI.

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