BackgroundContinuous infusion of vancomycin is increasingly preferred as an alternative to intermittent administration in critically ill patients. Intermittent vancomycin treatment is associated with an increased occurrence of nephrotoxicity. This study was designed to determine the incidence and risk factors of acute kidney injury (AKI) during continuous infusion of vancomycin.MethodsThis was a retrospective, observational, two-center, cohort study in patients with microbiologically documented Gram-positive pneumonia and/or bacteremia and normal baseline renal function. Vancomycin dose was adjusted daily aiming at plateau concentrations of 15-25 μg/mL. AKI was defined as an increase in serum creatinine of 0.3 mg/dL or a 1.5 to 2 times increase from baseline on at least 2 consecutive days after the initiation of vancomycin. Primary data analysis compared patients with AKI with patients who did not develop AKI. A binary logistic regression analysis using the forward stepwise method was used to assess the risk factors associated with AKI.ResultsA total of 129 patients were studied of whom 38 (29.5%) developed AKI. Patients with AKI had higher body weight (77.3 ± 15 vs. 70.5 ± 15.2 kg; p = 0.02), more diabetes (79% vs. 54%; p = 0.01), and a higher vasopressor need (87% vs. 59%; p = 0.002). Serum vancomycin levels, body weight, and SAPS 3 score were identified as variables contributing to AKI. The incidence of AKI increased substantially when treatment duration was prolonged (14.9 ± 9.8 vs. 9.2 ± 4.9 days; p = 0.05) and plasma levels exceeded 30 μg/mL.ConclusionsAKI is frequently observed during continuous vancomycin infusion, particularly when conditions that cause acute (shock) or chronic (diabetes) renal dysfunction are present and vancomycin levels above target range are achieved. Although this study challenges the concept that continuous vancomycin infusion might alleviate the risk of nephrotoxicity in critically ill patients, a direct relationship between vancomycin and nephrotoxicity remains to be proven.

The negative correlation between TPV and CE present only in autologous collection procedures can be explained by the limited intra-apheresis recruitment of CD34+ cells into the blood which is negatively influenced by extensive pre-treatment. As a result of this study we decided to limit TPV to a maximum of three times the patient's blood volume in autologous apheresis procedures at our center.

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Progressive increase of old patients with end stage renal disease (ESRD) with a high mortality and morbidity rate, receiving haemodialysis, increases the impact of psychosocial factors on the outcome. Depression is the most prevalent psychological problem in patients in haemodialysis and is associated with a high mortality. The purpose of this study was to evaluate the functional (ADL, IADL), mental (MMSE, SDS) state and the Quality of Life (KDQOL) in the chronic haemodialysis patients. Old patients can be successfully treated by haemodialysis and therefore age may never be used as exclusion for initiative haemodialysis. Formal geriatric assessment should be imperative for the older person with end stage renal disease since all elderly patients become dependent. The high prevalence of depression in our haemodialysis population needs further investigation.