Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study

Zhao, Jinjin; Fan, Yaxin; Yang, Mei; Liang, Xiaoyu; Wu, Jiang; Chen, Yuancheng; Guo, Beining; Zhang, Huifang; Wang, Ruilan; Zhang, Fengying; Hang, Jingqing; Li, Huayin; Zhang, Jing

doi:10.3390/antibiotics11070837

Cited by 7 publications

(14 citation statements)

References 38 publications

(67 reference statements)

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“…In contrast to earlier findings, researchers could not confirm that ARC occurred more often in males[30]. Moreover, Zhao et al identified risk factors associated with ARC in Chinese adult patients, which included the male gender, age < 50 years, overweight, receiving mechanical ventilation, enteral nutrition, neutrophil percentage, and cardiovascular diseases[31].…”

mentioning

confidence: 76%

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

Alzahrani¹,

Hakami²,

AlAzmi³

et al. 2022

Cureus

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Introduction: Vancomycin administration in individuals with hematological malignancy or neutropenia is associated with a suboptimal trough concentration. Nonetheless, most studies did not distinguish whether low vancomycin trough concentrations were due to hematological malignancies or neutropenia. This study aimed to determine the association between types of hematological malignancy and febrile neutropenia with low vancomycin concentrations.Methods: The present retrospective chart review study was conducted by using clinical data adopted from computerized physician order entries (BestCare®) for all of the patients who received intravenous vancomycin treatment between January 2017 and December 2020 at King Abdulaziz Medical City in Jeddah.Results: Out of the 296 patients, 217 were included. There was no significant association between the type of hematological malignancy and the incidence of a low trough concentration (p > 0.05), while a significant association between febrile neutropenia and the incidence of a low trough concentration was observed (p < 0.05). Furthermore, the predictors for a low trough among febrile neutropenic patients were creatinine clearance (CrCI) and a low albumin concentration. In addition, there was a significant association between febrile neutropenia and augmented renal clearance (p < 0.05).Conclusions: The findings of this study conclude that febrile neutropenia is associated with low vancomycin concentrations. Interestingly, augmented renal clearance was observed in most of the febrile neutropenia patients with a significant association, which is considered the main driver for a low trough in neutropenic patients.

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confidence: 76%

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

Alzahrani¹,

Hakami²,

AlAzmi³

et al. 2022

Cureus

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“…In the vast majority of the included studies, critically ill patients were compared based on the presence or absence of ARC. ARC prevalence among these patients ranged from 16.4% to 72% [10,18,19,[22][23][24][25][26][27]. The comparisons consistently revealed that younger age, male sex, heavier weight, lower illness severity, and the presence of brain injury or trauma were the factors most frequently linked with a higher risk for ARC.…”

Section: Arc Definition and Its Prevalencementioning

confidence: 88%

“…The comparisons consistently revealed that younger age, male sex, heavier weight, lower illness severity, and the presence of brain injury or trauma were the factors most frequently linked with a higher risk for ARC. Other associated factors could be receiving mechanical ventilation, enteral nutrition, hemodynamic instability, low serum albumin, low platelet count, low serum creatinine, high glomerular filtration rate, presence of TBI, febrile neutropenia, trauma, intracerebral hemorrhage, and aneurysmal subarachnoid hemorrhage [20,23,26,28]. Furthermore, Zhao J et al [26] conducted a study that aimed to evaluate two widely used scoring systems (ARCTIC and ARC risk scoring) to help define high ARC risk factors, revealing that 58.9% of ARC patients had high-risk scores when assessed in the ICU, while 88.9% had high-risk scores among trauma patients.…”

Section: Arc Definition and Its Prevalencementioning

confidence: 99%

The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

Tesfamariam,

Aboelezz,

Mahmoud

2024

JCM

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Augmented renal clearance (ARC), defined as a creatinine clearance (CrCl) > 130 mL/min/1.73 m2, is observed in 30–65% of critically ill patients. When following standard dosage guidelines, patients with ARC often experience subtherapeutic vancomycin levels, resulting in treatment failure due to accelerated drug elimination. This review aims to explore ARC’s impact on vancomycin pharmacokinetics and pharmacodynamics (PK/PD) indices in ARC patients, seeking to identify an accurate dose adjustment method for this patient population. In September 2023, a comprehensive literature search was conducted on the MEDLINE and EMBASE databases to include all available studies providing information on the impact of ARC on vancomycin therapy in critically ill adults. Articles that studied the pediatric population and those with insufficient PK data were excluded. A total of 21 articles met the inclusion criteria. The findings revealed a positive correlation between CrCl and vancomycin clearance, indicating low serum concentrations. Therefore, upward dosing adjustments are necessary to improve treatment success. Younger age consistently emerged as a major contributor to ARC and vancomycin PK/PD alterations. This study summarizes the PK/PD alterations, current dosage recommendations and proposes preliminary recommendations on possible dosing approaches to decrease the risk of subtherapeutic exposure in this patient population.

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“…Previous studies have observed that patients with ARC have insufficient therapeutic concentrations of antibiotics; therefore, these patients are at a high risk of treatment failure. Inadequate therapeutic concentrations are more likely associated with antibiotics that undergo renal elimination (Chen and Nicolau, 2020;Zhao et al, 2022). Chu et al conducted a retrospective study in patients receiving vancomycin at dose of 1,000 mg every 12 h. The trough of vancomycin then measured and they observed that vancomycin trough concentrations were lower than the minimum recommended range in 62.9% of patients who showed ARC.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

et al. 2022

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Purpose: Vancomycin is a narrow therapeutic window glycopeptide antibiotic that acts against Gram-positive bacteria. As it is renally eliminated, therapeutic drug monitoring is recommended for vancomycin, especially in case of kidney function alteration. Augmented renal clearance (ARC), defined as a creatinine clearance of more than 130 ml/min, is a risk factor for sub-therapeutic concentrations of vancomycin. This study aimed to evaluate the vancomycin pharmacokinetics following the administration of two different regimens in ARC patients.Methods: A randomized clinical trial (IRCT20180802040665N1) was conducted on patients in need of vancomycin therapy. Eight hours of urine was collected and 56 patients divided into two groups with creatinine clearance of more than 130 ml/min were included in the study. The first group received 15 mg/kg of vancomycin every 12 h and the second group 15 mg/kg every 8 h. After four doses, the peak and trough concentrations were measured from two blood samples. The primary outcome was the percentage of patients who attainted AUC more than 400. The occurrence of acute kidney injury also was evaluated after seven days.Results: The mean age of patients in the every 12 h and every 8 h groups was 44.04 ± 16.55 and 42.86 ± 11.83 years, respectively. While neurosurgical issues were the most common causes of hospitalization, central nervous infections were the most common indications for vancomycin initiation. Urinary creatinine clearance was 166.94 ± 41.32 ml/min in the every 12 h group and 171.78 ± 48.56 ml/min in the every 8 h group. 46.42% of patients in the every 12 h group and 82.14% of patients in the every 8 h group attained AUC/MIC of more than 400 mg × hr/L. None of the patients in the every 12 h group reached more than 15 mcg/ml concentration. At the 7-day follow-up, 10.7% patients in the BD group and 28.6% patients in the TDS group developed acute kidney injury (p = 0.089).Conclusion: Administration of vancomycin at a dose of 15 mg/kg every 8 h is associated with higher pharmacokinetic attainment in ARC patients. The occurrence of acute kidney injury also was not significantly higher in this therapeutic regimen. AUC/MIC monitoring is necessary in this population.

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Association between Augmented Renal Clearance and Inadequate Vancomycin Pharmacokinetic/Pharmacodynamic Targets in Chinese Adult Patients: A Prospective Observational Study

Cited by 7 publications

References 38 publications

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

Augmented Renal Clearance and Hypoalbuminemia-Induced Low Vancomycin Trough Concentrations in Febrile Neutropenic Patients With Hematological Malignancies

The Impact of Augmented Renal Clearance on Vancomycin Pharmacokinetics and Pharmacodynamics in Critically Ill Patients

Evaluation of vancomycin pharmacokinetics in patients with augmented renal clearances: A randomized clinical trial

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