Effect of various estimates of renal function on prediction of vancomycin concentration by the population mean and Bayesian methods

Tsuji, Yasuhiro; Hiraki, Yoichi; Mizoguchi, Akiko; Sadoh, Shinichi; Sonemoto, Emi; Kamimura, Hidetoshi; Karube, Yoshiharu

doi:10.1111/j.1365-2710.2008.01015.x

Cited by 11 publications

(14 citation statements)

References 18 publications

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“…The coefficients of the CG equation have never been revised for modern, IDMS traceable serum creatinine assays. Tsuji et al have shown that converting enzymatic S Cr values into corresponding Jaffe values may significantly improve the performance of the CG equation as a covariate to predict vancomycin concentrations (34). However, in our opinion, it is unlikely that clinicians will perform such conversion in routine clinical practice.…”

Section: Discussionmentioning

confidence: 86%

“…A study conducted with Japanese elderly patients compared the performance of the CG equation based on enzymatic S Cr , the CG equation based on Jaffeconverted S Cr , and the MDRD equation in predicting vancomycin trough levels using a Bayesian approach (34). When the mean value of the population PK parameters was used to predict vancomycin concentrations (a priori prediction), the CG equation based on Jaffe-converted S Cr provided the best predictive performance.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Renal Function Estimation on Pharmacokinetic Modeling of Vancomycin in Elderly Patients

Glatard

Bourguignon

Jelliffe³

et al. 2015

Antimicrob Agents Chemother

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Vancomycin is a renally excreted drug, and its body clearance correlates with creatinine clearance. However, the renal function estimation equation that best predicts vancomycin clearance has not been established yet. The objective of this study was to compare the abilities of different renal function estimation equations to describe vancomycin pharmacokinetics in elderly patients. The NPAG algorithm was used to perform population pharmacokinetic analysis of vancomycin concentrations in 78 elderly patients. Six pharmacokinetic models of vancomycin clearance were built, based on the following equations: CockcroftGault (CG), Jelliffe (JEL), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) (both in milliliters per minute per 1.73 m 2 ), and modified MDRD and CKD-EPI equations (both in milliliters per minute). Goodness-of-fit and predictive performances of the six PK models were compared in a learning set (58 subjects) and a validation set (20 patients). Final analysis was performed to estimate population parameters in the entire population. In the learning step, the MDRD-based model best described the data, but the CG-and JEL-based models were the least biased. The mean weighted errors of prediction were significantly different between the six models (P ‫؍‬ 0.0071). In the validation group, predictive performances were not significantly different. However, the use of a renal function estimation equation different from that used in the model building could significantly alter predictive performance. The final analysis showed important differences in parameter distributions and AUC estimation across the six models. This study shows that methods used to estimate renal function should not be considered interchangeable for pharmacokinetic modeling and model-based estimation of vancomycin concentrations in elderly patients.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Influence of Renal Function Estimation on Pharmacokinetic Modeling of Vancomycin in Elderly Patients

Glatard

Bourguignon

Jelliffe³

et al. 2015

Antimicrob Agents Chemother

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“…They concluded that the optimized CG equation was the most appropriate of the three equations examined to dose renally eliminated drugs. Conversely, a study by Tsuji et al found that if the serum creatinine is measured using the Jaffe method, instead of the IDMS method, then a correction of serum creatinine to 0.68 mg/dL is unnecessary within the CG equation [56]. Additionally, a study by Glatard et al found that the CG equation, MDRD equation, and CKD-EPI equations are not interchangeable when calculating vancomycin dosing and prediction of concentrations based on renal function [57].…”

Section: Key Clinical Issuesmentioning

confidence: 99%

“…As vancomycin is approximately 90% renally eliminated unchanged in the urine [56, 57], it is imperative to accurately estimate renal function when calculating dosing regimens to help optimize the pharmacokinetic and pharmacodynamic properties of the drug. Cutler et al compared vancomycin kinetics in younger patients (mean age: 23 years) versus older patients (mean age: 68 years) [58].…”

Section: Key Clinical Issuesmentioning

confidence: 99%

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

et al. 2016

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The elderly population can be divided into three distinct age groups: 65–74 years (young-old), 75–84 years (middle-old), and 85+ years (old-old). Despite evidence of a shift in leading causes for mortality in the elderly from infectious diseases to chronic conditions, infections are still a serious cause of death in this population. These patients are at increased risk due to weakened immune systems, an increased prevalence of underlying comorbidities, and decreased physiologic reserves to fight infection. Additionally, elderly patients, especially adults in institutional settings, are at an increased risk of colonization and subsequent infection with methicillin-resistant Staphylococcus aureus at a rate that is five times higher than in younger individuals, causing an increase in empiric and definitive vancomycin use. Elderly patients have unique characteristics that make dosing vancomycin a challenge for clinicians, such as increased volume of distribution and decreased renal function. Using the best available evidence, it is recommended to initiate lower empiric maintenance doses and monitor vancomycin serum concentrations earlier than steady state to accurately calculate drug elimination and make appropriate dose adjustments.

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“…Furthermore, the predictability of the serum concentration of VCM based on TDM estimated by the Cockcroft-Gault equation has been reported to be high in the elderly. 21) Thus, in this study, CrCL calculated with the Cockcroft-Gault equation was used as a substitute for the level of renal function.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Pharmacokinetic Parameters with Serum Vancomycin Concentration in Elderly Patients with Malignancies

2010

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Vancomycin (VCM) is a glycopeptide antibiotic that is generally used to treat methicillin-resistant Staphylococcus aureus (MRSA). Recently, it has been reported that VCM clearance (CL) is signiˆcantly higher in elderly patients and infants and children with malignancies, compared with those without malignancies. We have treated many patients with a variety of malignant tumors in whom serum VCM concentrations were found to be moderately lower during therapeutic drug monitoring (TDM). The aim of this study was to determine whether the presence of malignant tumors in‰uences trough concentrations of VCM and VCM pharmacokinetics in elderly patients during treatment for MRSA infection. Comparison of the clinical characteristics and VCM pharmacokinetic parameters between patients with and without malignancies was undertaken in 49 elderly Japanese patients infected with MRSA. The mean trough concentration of VCM in patients with malignancies was signiˆcantly lower than that in patients without malignancies. Our results showed signiˆcantly higher values of VCM CL and volume of distribution and a shorter elimination half-life in patients with malignancies. Univariate logistic regression analysis of the pharmacokinetic parameters indicated that VCM CL contributed as a signiˆcant factor independent of the relation to malignant tumor. In conclusion, it is suggested that the therapeutic eŠects and side eŠects of VCM should be actively monitored using TDM, because concentrations may decrease when CL increases in VCM therapy for elderly patients with malignant tumors.

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Effect of various estimates of renal function on prediction of vancomycin concentration by the population mean and Bayesian methods

Cited by 11 publications

References 18 publications

Influence of Renal Function Estimation on Pharmacokinetic Modeling of Vancomycin in Elderly Patients

Influence of Renal Function Estimation on Pharmacokinetic Modeling of Vancomycin in Elderly Patients

Intravenous Vancomycin Dosing in the Elderly: A Focus on Clinical Issues and Practical Application

Correlation of Pharmacokinetic Parameters with Serum Vancomycin Concentration in Elderly Patients with Malignancies

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