Aminoglycoside-Associated Nephrotoxicity in the Elderly

Baciewicz, Anne M.; Sokos, Denise R; Cowan, Ronald I

doi:10.1177/106002800303700203

Cited by 29 publications

(13 citation statements)

References 13 publications

(10 reference statements)

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“…In a clinical study involving 86 elderly patients, diabetes was associated with an increased rate of aminoglycoside-associated nephrotoxicity. In that study, 9.3% of the patients receiving aminoglycosides developed nephrotoxicity, and diabetes mellitus was identified by logistic regression as a risk factor for aminoglycoside-associated kidney injury (2). On the other hand, a study of 249 elderly patients receiving amikacin or gentamicin did not find diabetes to be a risk factor for nephrotoxicity, based on logistic regression analysis (29).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units

Oliveira

Silva

Barbieri

et al. 2009

Antimicrob Agents Chemother

150

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In order to assess the prevalence of and risk factors for aminoglycoside-associated nephrotoxicity in intensive care units (ICUs), we evaluated 360 consecutive patients starting aminoglycoside therapy in an ICU. The patients had a baseline calculated glomerular filtration rate (cGFR) of >30 ml/min/1.73 m 2 . Among these patients, 209 (58%) developed aminoglycoside-associated nephrotoxicity (the acute kidney injury [AKI] group, which consisted of individuals with a decrease in cGFR of >20% from the baseline cGFR), while 151 did not (non-AKI group). Both groups had similar baseline cGFRs. The AKI group developed a lower cGFR nadir (45 ؎ 27 versus 79 ؎ 39 ml/min/1.73 m 2 for the non-AKI group; P < 0.001); was older (56 ؎ 18 years versus 52 ؎ 19 years for the non-AKI group; P ‫؍‬ 0.033); had a higher prevalence of diabetes (19.6% versus 9.3% for the non-AKI group; P ‫؍‬ 0.007); was more frequently treated with other nephrotoxic drugs (51% versus 38% for the non-AKI group; P ‫؍‬ 0.024); used iodinated contrast more frequently (18% versus 8% for the non-AKI group; P ‫؍‬ 0.0054); and showed a higher prevalence of hypotension (63% versus 44% for the non-AKI group; P ‫؍‬ 0.0003), shock (56% versus 31% for the non-AKI group; P < 0.0001), and jaundice (19% versus 8% for the non-AKI group; P ‫؍‬ 0.0036). The mortality rate was 44.5% for the AKI group and 29.1% for the non-AKI group (P ‫؍‬ 0.0031). A logistic regression model identified as significant (P < 0.05) the following independent factors that affected aminoglycoside-associated nephrotoxicity: a baseline cGFR of <60 ml/min/1.73 m 2 (odds ratio [OR], 0.42), diabetes (OR, 2.13), treatment with other nephrotoxins (OR, 1.61) or iodinated contrast (OR, 2.13), and hypotension (OR, 1.83). In conclusion, AKI was frequent among ICU patients receiving an aminoglycoside, and it was associated with a high rate of mortality. The presence of diabetes or hypotension and the use of other nephrotoxic drugs and iodinated contrast were independent risk factors for the development of aminoglycoside-associated nephrotoxicity.

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Section: Discussionmentioning

confidence: 99%

“…However, the majority of published studies (2,5,24,27,29,30,32) did not evaluate several of the most important risk factors simultaneously, had small sample sizes, or did not use appropriate statistical methods for risk factor assessment. In addition, few studies analyzed ICU patients.…”

mentioning

confidence: 99%

Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units

Oliveira

Silva

Barbieri

et al. 2009

Antimicrob Agents Chemother

150

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“…When still required, the potential efficacy of single-dose daily regimens (or other extended dosing treatment programs) of aminoglycosides versus multiple-daily dosing strategies has been extensively studied in numerous controlled and uncontrolled clinical studies over many years [110-121], and the subject has been the focus of a number of formal meta-analyses [122-127]. The cumulative results of this evidence-based review and numerous meta-analyses indicate that once-daily dosing strategies generally result in less AKI when compared with multiple-dose dosing strategies, although the benefit accrued by the single-daily dose strategy is modest and inconsistent across a number of these studies.…”

Section: Recommendations and Rationalementioning

confidence: 99%

Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

2013

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Acute kidney injury (AKI) is a common and serious problem affecting millions and causing death and disability for many. In 2012, Kidney Disease: Improving Global Outcomes completed the first ever, international, multidisciplinary, clinical practice guideline for AKI. The guideline is based on evidence review and appraisal, and covers AKI definition, risk assessment, evaluation, prevention, and treatment. In this review we summarize key aspects of the guideline including definition and staging of AKI, as well as evaluation and nondialytic management. Contrast-induced AKI and management of renal replacement therapy will be addressed in a separate review. Treatment recommendations are based on systematic reviews of relevant trials. Appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and a detailed rationale for each recommendation is provided.

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“…[15][16][17][18][19][20] However, it is well known that aminoglycosides are nephrotoxic and that prolonged treatment duration increases the risk of renal function impairment. [21][22][23][24] An important question therefore is whether it is necessary to treat enterococcal IE with gentamicin for as long as 4 to 6 weeks to obtain a sufficient cure rate.…”

mentioning

confidence: 99%

Enterococcus faecalis Infective Endocarditis

et al. 2013

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Background-Because of the nephrotoxic effects of aminoglycosides, the Danish guidelines on infective endocarditis were changed in January 2007, reducing gentamicin treatment in enterococcal infective endocarditis from 4 to 6 weeks to only 2 weeks. In this pilot study, we compare outcomes in patients with Enterococcus faecalis infective endocarditis treated in the years before and after endorsement of these new recommendations. Methods and Results-A total of 84 consecutive patients admitted with definite left-sided E faecalis endocarditis in the period of 2002 to 2011 were enrolled. Forty-one patients were treated before and 43 patients were treated after January 1, 2007. There were no significant differences in baseline characteristics. At hospitalization, the 2 groups had similar estimated glomerular filtration rates of 66 and 75 mL/min (P=0.22). Patients treated before January 2007 received gentamicin for a significantly longer period (28 versus 14 days; P<0.001). The primary outcome, 1-year event-free survival, did not differ: 66% versus 69%, respectively (P=0.75). At discharge, the patients treated before 2007 had a lower estimated glomerular filtration rate (45 versus 66 mL/min; P=0.008) and a significantly greater decrease in estimated glomerular filtration rate (median, 11 versus 1 mL/min; P=0.009) compared with those treated after 2007. Conclusions-Our present pilot study suggests that the recommended 2-week treatment with gentamicin seems adequate and preferable in treating non-high-level aminoglycoside-resistant E faecalis infective endocarditis. The longer duration of gentamicin treatment is associated with worse renal function. Although the certainty of the clinical outcomes is limited by the sample size, outcomes appear to be no worse with the shorter treatment duration. Randomized, controlled studies are warranted to substantiate these results. Dahl et al Gentamicin in Enterococcal Endocarditis 1811 Methods DatabaseData from consecutive patients diagnosed with IE in 2 tertiary heart centers in Copenhagen, Denmark, were prospectively collected beginning on October 1, 2002. These 2 highly specialized university hospitals serve as the only referral centers for IE patients in the eastern part of Denmark and cover a catchment area of 2.4 million people. The diagnosis of IE was based on clinical, microbiological, and echocardiographic findings. Patients were enrolled in the database if they met the revised Duke criteria 25 of definite or possible IE. Patients with possible IE were included only if they received treatment as patients with definite IE. All data were collected with a standardized case report form with >250 variables, including demographics; medical history; physical examination findings; results of blood tests, including blood cultures; ECG; antibiotic use; surgical treatment; and findings of both transthoracic and transesophageal echocardiography. Duration of symptoms was defined as the time from the appearance of the first symptoms of IE (reported by the patient or his or her close famil...

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Aminoglycoside-Associated Nephrotoxicity in the Elderly

Cited by 29 publications

References 13 publications

Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units

Prevalence and Risk Factors for Aminoglycoside Nephrotoxicity in Intensive Care Units

Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)

Enterococcus faecalis Infective Endocarditis

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