Vancomycin Associated Acute Kidney Injury: A Longitudinal Study in China

Background: Vancomycin-associated acute kidney injury (VA-AKI) is a recognizable condition with known risk factors. However, the use of vancomycin in clinical practices in China is distinct from other countries. We conducted this longitudinal study to show the characteristics of VA-AKI and how to manage it in clinical practice.Patients and Methods: We included patients admitted to hospital, who received vancomycin therapy between January 1, 2016 and June 2019. VA-AKI was defined as a patient having developed AKI during vancomycin therapy or within 48 h following the withdrawal of vancomycin therapy.Results: A total of 3719 patients from 7058 possible participants were included in the study. 998 patients were excluded because of lacking of serum creatinine measurement. The incidence of VA-AKI was 14.3%. Only 32.3% (963/2990) of recommended patients performed therapeutic drug monitoring of vancomycin. Patients with VA-AKI were more likely to concomitant administration of cephalosporin (OR 1.55, 95% CI 1.08–2.21, p = 0.017), carbapenems (OR 1.46, 95% CI 1.11–1.91, p = 0.006) and piperacillin-tazobactam (OR 3.12, 95% CI 1.50–6.49, p = 0.002). Full renal recovery (OR 0.208, p = 0.005) was independent protective factors for mortality. Compared with acute kidney injury stage 1, AKI stage 2 (OR 2.174, p = 0.005) and AKI stage 3 (OR 2.210, p = 0.005) were independent risk factors for fail to full renal recovery.Conclusion: Lack of a serum creatinine measurement for the diagnosis of AKI and lack of standardization of vancomycin therapeutic drug monitoring should be improved. Patient concomitant with piperacillin-tazobactam are at higher risk. Full renal recovery was associated with a significantly reduced morality.

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Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis

Critical Care ◽

10.1186/s13054-019-2673-5 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 8

Author(s):

Jing Zhang ◽

Siobhan Crichton ◽

Alison Dixon ◽

Nina Seylanova ◽

Zhiyong Y. Peng ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Renal Function ◽

Fluid Balance ◽

Tertiary Care ◽

Kidney Injury ◽

Renal Recovery ◽

Partial Recovery ◽

Factors Associated ◽

Cumulative Fluid Balance

Abstract Background Acute kidney injury (AKI) is common in patients in the intensive care unit (ICU) and may be present on admission or develop during ICU stay. Our objectives were (a) to identify factors independently associated with the development of new AKI during early stay in the ICU and (b) to determine the risk factors for non-recovery of AKI. Methods We retrospectively analysed prospectively collected data of patients admitted to a multi-disciplinary ICU in a single tertiary care centre in the UK between January 2014 and December 2016. We identified all patients without AKI or end-stage renal failure on admission to the ICU and compared the outcome and characteristics of patients who developed AKI according to KDIGO criteria after 24 h in the ICU with those who did not develop AKI in the first 7 days in the ICU. Multivariable logistic regression was applied to identify factors associated with the development of new AKI during the 24–72-h period after admission. Among the patients with new AKI, we identified those with full, partial or no renal recovery and assessed factors associated with non-recovery. Results Among 2525 patients without AKI on admission, the incidence of early ICU-acquired AKI was 33.2% (AKI I 41.2%, AKI II 35%, AKI III 23.4%). Body mass index, Sequential Organ Failure Assessment score on admission, chronic kidney disease (CKD) and cumulative fluid balance (FB) were independently associated with the new development of AKI. By day 7, 69% had fully recovered renal function, 8% had partial recovery and 23% had no renal recovery. Hospital mortality was significantly higher in those without renal recovery. Mechanical ventilation, diuretic use, AKI stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently associated with non-recovery with cumulative fluid balance having a U-shape association. Conclusions Early development of AKI in the ICU is common and mortality is highest in patients who do not recover renal function. Extreme negative and positive FB were strong risk factors for AKI non-recovery.

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Serum Creatinine Measurement Immediately After Cardiac Surgery and Prediction of Acute Kidney Injury

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2011.08.023 ◽

2012 ◽

Vol 59 (2) ◽

pp. 196-201 ◽

Cited By ~ 45

Author(s):

Julie Ho ◽

Martina Reslerova ◽

Brent Gali ◽

Peter W. Nickerson ◽

David N. Rush ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Serum Creatinine ◽

Kidney Injury ◽

Creatinine Measurement ◽

Serum Creatinine Measurement

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PREDICTORS IN-HOSPITAL MORTALITY OF SEPTIC VS NON-SEPTIC ACUTE KIDNEY INJURY PATIENTS: AN OBSERVATIONAL COHORT STUDY

F1000Research ◽

10.12688/f1000research.74540.1 ◽

2021 ◽

Vol 10 ◽

pp. 1184

Author(s):

Nur Samsu ◽

Mochammad Jalalul Marzuki ◽

Irma Chandra Pratiwi ◽

Ratna Adelia Pravitasari ◽

Achmad Rifai ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cohort Study ◽

Hospital Mortality ◽

Kidney Injury ◽

Tertiary Hospital ◽

Renal Recovery ◽

Predictors Of Mortality ◽

Septic Acute Kidney Injury ◽

Observational Cohort

Background: To compare the predictors In-hospital mortality of patients with septic Acute Kidney Injury (S-AKI) and non-septic AKI (NS-AKI). Methods: a cohort study of critically ill patients with AKI admitted to the emergency room at a tertiary hospital from January to June 2019. The primary outcome was hospital mortality. Results: There were 116 patients who met the inclusion criteria. Compared with NS-AKI, patients with S-AKI had significantly lower mean MAP, median eGFR, and urine output. (UO). S-AKI had higher mortality and vasopressor requirements and had a lower renal recovery than NS-AKI (63.2% vs 31.4%, p=0.001; 30.8% vs 13.7%, p=0.031, and 36.9% vs 60.8%, p=0.011, respectively). AKI stage 3 and vasopressor requirements were dependent risk factors for both S-AKI and NS-AKI mortality. Meanwhile, SOFA score > 7 and the need for dialysis are dependent and independent risk factors for mortality in S-AKI. Worsening and/or persistence in UO, serum urea and creatinine levels at 48 h after admission were predictors of mortality in S-AKI and NS-AKI. Improvement in UO in surviving patients was more pronounced in S-AKI than in NS-AKI (50% vs 17.1%, p=0.007). The surviving S-AKI patients had a longer hospital stay than surviving NS-AKI [8 (6-14.5) vs 5 (4 – 8), p=0.004]. S-AKI have higher mortality and vasopressor requirements and have lower renal recovery than NS-AKI. Conclusion: S-AKI have higher mortality and vasopressor requirements and a lower renal recovery than NS-AKI. Independent predictors of mortality in S-AKI were high SOFA scores and the need for dialysis.

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Evaluation of a point‐of‐care serum creatinine measurement device and the impact on diagnosis of acute kidney injury in pediatric cardiac patients: A retrospective, single center study

Health Science Reports ◽

10.1002/hsr2.143 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Satoshi Kimura ◽

Tatsuo Iwasaki ◽

Kazuyoshi Shimizu ◽

Tomoyuki Kanazawa ◽

Hirokazu Kawase ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Point Of Care ◽

Kidney Injury ◽

Single Center ◽

Single Center Study ◽

The Impact ◽

Creatinine Measurement ◽

Serum Creatinine Measurement ◽

Center Study

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Acute kidney injury prevalence, progression and long-term outcomes in critically ill patients with COVID-19: a cohort study

Annals of Intensive Care ◽

10.1186/s13613-021-00914-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nuttha Lumlertgul ◽

Leah Pirondini ◽

Enya Cooney ◽

Waisun Kok ◽

John Gregson ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Steroid Therapy ◽

Critically Ill Patients ◽

Kidney Injury ◽

Renal Recovery ◽

Long Term Outcomes ◽

Icu Admission

Abstract Background There are limited data on acute kidney injury (AKI) progression and long-term outcomes in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to describe the prevalence and risk factors for development of AKI, its subsequent clinical course and AKI progression, as well as renal recovery or dialysis dependence and survival in this group of patients. Methods This was a retrospective observational study in an expanded tertiary care intensive care unit in London, United Kingdom. Critically ill patients admitted to ICU between 1st March 2020 and 31st July 2020 with confirmed SARS-COV2 infection were included. Analysis of baseline characteristics, organ support, COVID-19 associated therapies and their association with mortality and outcomes at 90 days was performed. Results Of 313 patients (70% male, mean age 54.5 ± 13.9 years), 240 (76.7%) developed AKI within 14 days after ICU admission: 63 (20.1%) stage 1, 41 (13.1%) stage 2, 136 (43.5%) stage 3. 113 (36.1%) patients presented with AKI on ICU admission. Progression to AKI stage 2/3 occurred in 36%. Risk factors for AKI progression were mechanical ventilation [HR (hazard ratio) 4.11; 95% confidence interval (CI) 1.61–10.49] and positive fluid balance [HR 1.21 (95% CI 1.11–1.31)], while steroid therapy was associated with a reduction in AKI progression (HR 0.73 [95% CI 0.55–0.97]). Kidney replacement therapy (KRT) was initiated in 31.9%. AKI patients had a higher 90-day mortality than non-AKI patients (34% vs. 14%; p < 0.001). Dialysis dependence was 5% at hospital discharge and 4% at 90 days. Renal recovery was identified in 81.6% of survivors at discharge and in 90.9% at 90 days. At 3 months, 16% of all AKI survivors had chronic kidney disease (CKD); among those without renal recovery, the CKD incidence was 44%. Conclusions During the first COVID-19 wave, AKI was highly prevalent among severely ill COVID-19 patients with a third progressing to severe AKI requiring KRT. The risk of developing CKD was high. This study identifies factors modifying AKI progression, including a potentially protective effect of steroid therapy. Recognition of risk factors and monitoring of renal function post-discharge might help guide future practice and follow-up management strategies. Trial registration NCT04445259

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The Benefit of Therapeutic Drug Monitoring of Vancomycin in a Respiratory ICU; A Patient with Acute Kidney Injury: A Case Report

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.62220 ◽

2018 ◽

Vol In Press (In Press) ◽

Cited By ~ 1

Author(s):

Lingti Kong ◽

Yulin Zhu ◽

Yong Zhang ◽

Haitao Liu

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Kidney Injury ◽

Therapeutic Drug

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Pregnancy-Related Acute Kidney Injury in Preeclampsia

Hypertension ◽

10.1161/hypertensionaha.119.13089 ◽

2019 ◽

Vol 74 (5) ◽

pp. 1144-1151 ◽

Cited By ~ 8

Author(s):

Frances I. Conti-Ramsden ◽

Hannah L. Nathan ◽

Annemarie De greeff ◽

David R. Hall ◽

Paul T. Seed ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Relative Risk ◽

Perinatal Mortality ◽

National Laboratory ◽

Kidney Injury ◽

Renal Recovery ◽

Post Discharge ◽

Middle Income ◽

Stage 1

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 μmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6–11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8–2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21–4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.

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Impact of an Antibiotic Stewardship Program on the Incidence of Vancomycin-Associated Acute Kidney Injury in Hospitalized Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-24.5.416 ◽

2019 ◽

Vol 24 (5) ◽

pp. 416-420

Author(s):

Alice Jenh Hsu ◽

Pranita D. Tamma

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Multivariable Analysis ◽

Kidney Injury ◽

Audit And Feedback ◽

Johns Hopkins Hospital ◽

Therapeutic Drug ◽

Prospective Audit ◽

Stewardship Program ◽

Prospective Audit And Feedback

OBJECTIVE Vancomycin causes considerable acute kidney injury (AKI) in children, particularly in the setting of troughs of 15 to 20 mg/L. We sought to determine whether the addition of prospective audit and feedback to a preauthorization and therapeutic drug monitoring (TDM) program further reduces the incidence of AKI. METHODS We conducted a quasiexperimental study of children admitted to The Johns Hopkins Hospital receiving vancomycin for ≥48 hours. The incidence of AKI was compared between the preintervention and intervention periods. Additional risk factors for vancomycin-associated AKI were also explored. RESULTS A total of 386 courses of vancomycin therapy met eligibility criteria (200 in the preintervention vs 186 in the intervention period). The incidence of vancomycin-associated AKI did not differ between the preintervention and intervention periods, 8% vs 9%, respectively. On multivariable analysis, the number of concurrent nephrotoxins was found to be an independent predictor of vancomycin-associated AKI, with each additional nephrotoxin increasing the risk of AKI by 40% (adjusted OR, 1.40; 95% CI, 1.06–1.85; p = 0.019). Specific nephrotoxins that increased the risk of vancomycin-associated AKI included piperacillin/tazobactam, liposomal amphotericin B, and ibuprofen. CONCLUSION The addition of prospective audit and feedback to a preauthorization and TDM program did not result in further AKI reduction. Prospective audit and feedback is a resource-intensive intervention. If preauthorization restrictions and TDM are already in place, our findings suggest stewardship efforts may be more effective if redirected to focus on other modifiable risk factors for vancomycin-associated AKI, such as minimizing additional nephrotoxins.

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