Evaluation of body weight-based vancomycin therapy and the incidence of nephrotoxicity: a retrospective study in the northwest of China

This exploratory study aimed to develop a risk prediction model of vancomycin-associated nephrotoxicity (VANT) in elderly patients. Clinical information of elderly patients who received vancomycin therapy from January 2016 to June 2018 was retrieved. A total of 255 patients were included in this study. Univariate analysis and multivariable logistic regression analysis revealed that vancomycin trough concentration ≥ 20 mg/L (odds ratio (OR) = 3.009; 95% confidence interval (CI) 1.345-6.732), surgery (OR = 3.357; 95% CI 1.309-8.605), the Charlson Comorbidities Index ≥ 4 points (OR = 2.604; 95% CI 1.172-5.787), concomitant use of cardiotonic drug (OR = 3.283; 95% CI 1.340-8.042), plasma volume expander (OR = 3.459; 95% CI 1.428-8.382), and piperacillin/tazobactam (OR = 2.547; 95% CI 1.680-6.007) were risk factors for VANT in elderly patients. Furthermore, a VANT risk prediction model was developed, which had good discriminative power and was well-calibrated.Vancomycin is used to treat methicillin-resistant Staphylococcus aureus (MRSA) infections. 1,2 Vancomycinassociated nephrotoxicity (VANT) 3 is a common adverse drug reaction, and is linked to the need for renal replacement therapy, prolonged hospitalization, higher healthcare costs, and increased mortality. 4 Elderly patients are more likely to develop VANT 5-7 due to multiple illnesses and complicated medications. The incidence of VANT in the general adult patients was 4.7-15.4%, [8][9][10][11] whereas the rate was 15.8-29% in elderly patients. 6,12 With the aging of our society, VANT in elderly patients is worthy of more attention. 12 Previous studies indicate that age, 7 mechanical ventilation, 12 intensive care unit (ICU) admittance, 13 vancomycin trough concentration, 9,14-17 dose, 15 length of therapy, 9,17 infusion method (continuous or intermittent infusions), 18,19 cirrhosis, 14 hypertension, 20 hyperuricemia, 12 shock, 6 heart failure, 6 concomitant medications, vasopressor drugs, 16,17 aminoglycosides, 9,21 contrast agents, 22,23 piperacillin/tazobactam (PTZ), 24,25 furosemide, 3,11 amphotericin B, 26 and the Acute Physiology and Chronic Health Evaluation II (APACHE-II) 21,27 are risk factors associated with VANT. However, only two studies reported VANT risk factors in elderly patients. 6,12 Additionally, there are few reports on developing risk prediction models of VANT in elderly patients. Therefore, we attempted to explore clinical predictors of VANT to construct a risk prediction model of VANT in elderly patients.

show abstract

“…Patients' clinical parameters were extracted mainly based on previous studies. 3,6,7,9,[12][13][14][15][16][17][18][19][20][21][22][23]26,27…”

Section: Data Extractionmentioning

confidence: 99%

Development and Validation of a Risk Prediction Model of Vancomycin‐Associated Nephrotoxicity in Elderly Patients: A Pilot Study

Pan

Wen

et al. 2020

Clinical Translational Sci

View full text Add to dashboard Cite

show abstract

“…This study is the first large scale investigation of VA-AKI in Hong Kong. In previous studies, the incidence of VA-AKI in Chinese varied from 2.4 to 45% [9,[13][14][15][16] (Additional file 1: Table S1). The difference of estimated incidence is due to different populations, sample sizes, inclusion criteria and AKI definition.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

et al. 2020

View full text Add to dashboard Cite

Background:To study the incidence of vancomycin-associated acute kidney injury (VA-AKI) in Hong Kong and identify risk factors for VA-AKI. Method: Patients with vancomycin prescription and blood level measurement in 2012-2016 were identified using the Hong Kong Hospital Authority Clinical Data Analysis and Reporting System. Acute kidney injury was defined using KDIGO criteria. Patients without creatinine measurements, steady-state trough vancomycin level or who had vancomycin treatment < 3 days were excluded. Results were analyzed using SPSS version 22.0. Logistic regression was used to identify the predictors for VA-AKI. Odds ratio and 95% confidence interval were estimated. Results: One thousand four hundred fifty patients were identified as VA-AKI from 12,758 records in Hong Kong in 2012-2016. The incidence was respectively 10.6, 10.9, 11.3, 12.2, 11.2% from 2012 to 2016. The incidence of VA-AKI was 16.3, 12.2, 11.3 and 6.2% in patients aged 1-12, 12-60, elderly aged > 60 and newborn and infants, respectively. Baseline creatinine, serum trough vancomycin level, systematic disease history including respiratory failure, hypertension, congestive heart failure, chronic renal failure, anemia and type II diabetes, and concomitant diuretics, piperacillin-tazobactam (PTZ) and meropenem prescription were significantly higher in VA-AKI patients older than 12 years. Logistic regression showed that older age group, higher baseline creatinine, serum trough vancomycin level, respiratory failure, chronic renal failure and congestive heart failure, concomitant diuretics, PTZ and meropenem prescription, and longer hospital stay were all associated with increased risk of VA-AKI. Conclusion: The incidence of VA-AKI in Hong Kong is low but shows no decline. Patients with higher baseline creatinine, multi-organ diseases and multiple drugs administration should have their vancomycin level monitored to decrease the risk of VA-AKI.

show abstract

“…There is evidence that the incidence of vancomycin-induced nephrotoxicity varies in a range from 5% to 43%, and depends on the trough level (approximately double at the trough level of >15 mg/l compared to the trough level of 15 mg/l: 25% vs. 12%) (van Hal et al, 2013). In a study by Dong et al (2015), patients given a weight-based dose (20-45 mg/kg/day) developed nephrotoxicity at an incidence of 15.6%. The present study showed that the use of vancomycin led to mild changes in renal function based on BUN, SCr, and eGFR levels, but nephrotoxicity only developed with a lower incidence of 5.9%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the variability and safety of serum trough concentrations of vancomycin in patients admitted to the intensive care unit

Qian

Chun-mei

et al. 2017

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

Evaluation of body weight-based vancomycin therapy and the incidence of nephrotoxicity: a retrospective study in the northwest of China

Abstract: The data from this study indicate that a vancomycin dosage >38mg/kg/day and a serum trough level >20mg/l are both independent factors associated with the development of nephrotoxicity, suggesting that renal function should be monitored closely during vancomycin treatment.

Cited by 17 publications

References 44 publications

Development and Validation of a Risk Prediction Model of Vancomycin‐Associated Nephrotoxicity in Elderly Patients: A Pilot Study

Development and Validation of a Risk Prediction Model of Vancomycin‐Associated Nephrotoxicity in Elderly Patients: A Pilot Study

Vancomycin-associated acute kidney injury in Hong Kong in 2012–2016

Evaluation of the variability and safety of serum trough concentrations of vancomycin in patients admitted to the intensive care unit

Contact Info

Product

Resources

About