Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin

Sinclair, Elizabeth A.; Yenokyan, Gayane; McMunn, Andrea; Fadrowski, Jeffrey J.; Milstone, Aaron M.; Lee, Carlton K. K.

doi:10.1177/1060028014549185

Cited by 61 publications

(78 citation statements)

References 43 publications

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“…While we found that 23.4% of our study population developed AKI (any category), the frequency of pRIFLE category I and F (5.3%) was slightly lower than previously reported rates of pRIFLE category I in the PICU. 7,9 Totapally et al 7 and Sinclair et al 9 found that 17.2% and 13.7% of patients developed pRIFLE category I, respectively, which is threefold greater than our result of 5.3% that developed either category I or F. This may be due to the fact that our study did not include repeat courses of vancomycin for individual patients. 7 Our results on concomitant risk factors are overall similar to the results in the current literature.…”

Section: Discussioncontrasting

confidence: 55%

“…Conversely, Totapally et al 7 did not find any association between trough concentrations and AKI. Interestingly, Sinclair et al 9 did not include trough concentrations in their multiple logistic regression analysis, but maximum troughs were significantly higher in patients who developed AKI.…”

Section: Discussionmentioning

confidence: 99%

“…1 Estimates of the incidence of AKI associated with vancomycin in pediatrics range from 5% to 27.2%. [4][5][6][7][8][9] However, evidence is conflicting regarding the relationship between PICU admission, vancomycin use, and AKI. McKamy et al 4 studied children on vancomycin in all hospital wards (n = 167) and defined AKI as a 50% baseline increase in serum creatinine (SCr) or an increase of 0.5 mg/dL.…”

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

“…Knoderer et al 5 studied children on vancomycin in all hospital wards (n = 859) and AKI was defined as meeting pRIFLE category I ( 5 Of note, studies have shown that there is no association between AKI and total daily dose of vancomycin, rather that the serum levels of vancomycin are the important factor in development of AKI. 4,5,7 Totapally et al 7 performed a retrospective analysis on PICU patients who received vancomycin for at least 3 days (n = 391 courses) with AKI defined as pRIFLE category I (Table 1) 9 reported that concurrent use of nephrotoxic medications, and longer duration of therapy were associated with increased odds of AKI (defined as pRIFLE category I; Table 1). Also, maximum trough concentrations in the initial 96 hours of therapy were higher in patients with AKI (p = 0.021).…”

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

“…4,[6][7][8][9] A study of risk factors specifically in PICU patients is necessary to improve the understanding of AKI risk with vancomycin, including analysis of vancomycin factors (duration, trough levels) and other independent risk factors, such as concomitant nephrotoxins.…”

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

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Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Bonazza

Bresee

Kraft

et al. 2016

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND:Published information evaluating frequency of and risk factors for vancomycin-induced acute kidney injury (AKI) in the pediatric intensive care unit (PICU) population is conflicting. OBJECTIVES: The primary objective was to describe the proportion of our PICU patients who developed AKI with intravenous (IV) vancomycin. The secondary objective was to describe the associated potential risk factors. METHODS: Pediatric patients (0-18 years) who received their first IV vancomycin dose in the PICU were evaluated in this retrospective chart review. AKI was defined based on Pediatric-Modified RIFLE (pRIFLE) criteria. Patient demographics, vancomycin trough concentrations, concomitant nephrotoxins, and estimated creatinine clearance changes were analyzed. RESULTS: Of 265 patients included, the primary outcome of AKI (defined by meeting any pRIFLE criteria) occurred in 62 (23.4%) patients (48 category R, 11 category I, 3 category F). Patients who received vancomycin treatment for ≥ 5 days were more likely to develop AKI (unadjusted odds ratio [uOR]: 2.52; 95% confidence interval [CI]: 1.11-5.73), as were patients with a maximum vancomycin trough level ≥ 20 mg/L (OR: 2.99; 95% CI: 1.54-5.78) and patients on 1 (uOR: 2.29; 95% CI: 1.12-4.66) or more concurrent nephrotoxin (uOR: 3.11; 95% CI: 1.43-6.77). Among nephrotoxins, patients receiving furosemide concomitantly with vancomycin were more likely to develop AKI (uOR: 3.47; 95% CI: 1.92-6.27). After adjustment, only furosemide was a significant predictor of risk of AKI/AKI (adjusted OR: 3.52; 95% CI: 1.88-6.62). The study was limited by its retrospective and observational design, and confounding variables. CONCLUSIONS: Patients who were receiving vancomycin with concurrent furosemide were at highest risk of developing AKI.INDEX TERMS: acute kidney injury, critical illness, drug monitoring, pediatrics, vancomycin J Pediatr Pharmacol Ther 2016;21(6): [486][487][488][489][490][491][492][493]

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

Section: Pediatric Acute Kidney Injury and Vancomycinmentioning

confidence: 99%

See 3 more Smart Citations

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Bonazza

Bresee

Kraft

et al. 2016

The Journal of Pediatric Pharmacology and Therapeutics

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The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Reilly

Ding

Rower

et al. 2019

The Journal of Clinical Pharma

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Concern for bacterial resistance and treatment failure with vancomycin trough concentrations < 10 μg/mL have led guidelines to increase goal concentrations. There is a paucity of data evaluating vancomycin dosage necessary to achieve goals in the neonatal intensive care unit (NICU). We aimed to evaluate the implementation of a new vancomycin dosing guideline in improving trough target attainment. This retrospective study evaluated neonates in the NICU treated with vancomycin between January 2009 and December 2015. Therapeutic trough concentration attainment (10-20 μg/mL) was compared between neonates receiving vancomycin per old versus new dosing guidelines. Vancomycin trough concentrations, modeled pharmacodynamic target attainment, and nephrotoxicity were compared between groups. A total of 212 vancomycin trough concentrations (n = 91 old and n = 121 new guideline) were evaluated in 182 unique neonates. The mean ± standard deviation trough concentration achieved was 18.0 ± 7.3 μg/mL vs 8.9 ± 4.8 μg/mL in the new and old guidelines, respectively (P < .01). The new guideline resulted in a higher percentage of neonates achieving trough concentrations of 10 to 20 μg/mL (62% vs 29%; P < .01) and decreased the percentage of neonates with subtherapeutic trough concentrations (9% vs 69%; P < .01). Pharmacokinetic modeling identified postmenstrual age, days of life, and urine output as predictors of vancomycin clearance and resultant trough and area under the curve values (P < .01 for all). Trough concentrations >10 μg/mL ensured area under the curve /minimum inhibitory concentration >400 in >90% of neonates when bacteria minimum inhibitory concentration was ࣘ 1 μg/mL. Nephrotoxicity was similar between groups (8.3% vs 7.7%; P = .99). In conclusion, a vancomycin nomogram designed to achieve trough concentration of 10 to 20 μg/mL improves pharmacodynamic target attainment in neonates in the NICU.

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Reducing acute kidney injury in pediatric oncology patients: An improvement project targeting nephrotoxic medications

Young

Dahale

Demmel

et al. 2020

Pediatric Blood & Cancer

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Background Nephrotoxic medication exposure and associated acute kidney injury (AKI) occur commonly in hospitalized children. At Cincinnati Children's Hospital Medical Center, there is an initiative to increase awareness of nephrotoxic medication exposure and decrease rates of associated AKI. The oncology service utilized these data in a quality improvement project to drive reductions in AKI rates. Methods Three interventions were implemented targeted at decreasing the incidence of nephrotoxic exposure, as well as protecting against the conversion of exposures to AKI episodes. Cefepime replaced piperacillin‐tazobactam for febrile neutropenia, vancomycin stewardship limited empiric courses to 72 hours, and nephroprotection for intravenous contrast administration was standardized for defined high‐risk patients. Results The study cohort comprised 42 520 noncritically ill patient days admitted to the oncology service at Cincinnati Children's Hospital Medical Center. A total of 273 unique patients were exposed to combination nephrotoxic medications, leading to 111 AKI episodes. The rate of nephrotoxic medication exposure within the oncology service decreased by 49% from 16.08 to 8.17 per 1000 patient days. Episodes of AKI associated with nephrotoxic medication exposure decreased by 45% from 3.48 to 1.92 per 1000 patient days. Conclusion Interventions to decrease AKI took a three‐pronged approach. Collectively, this approach was proven successful with significant reductions in both rates of nephrotoxic medication exposure and associated AKI among hospitalized oncology patients.

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Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin

Cited by 61 publications

References 43 publications

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

Frequency of and Risk Factors for Acute Kidney Injury Associated With Vancomycin Use in the Pediatric Intensive Care Unit

The Effectiveness of a Vancomycin Dosing Guideline in the Neonatal Intensive Care Unit for Achieving Goal Therapeutic Trough Concentrations

Reducing acute kidney injury in pediatric oncology patients: An improvement project targeting nephrotoxic medications

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