Serum cystatin C as a better marker of vancomycin clearance than serum creatinine in elderly patients

Okamoto, Go; Sakamoto, Tatsuichiro; Kimura, Midori; Ukishima, Yoshiyuki; Sonoda, Akinaga; Mori, Noriko; Kato, Yasuhiro; Maeda, Toshio; Kagawa, Yoshiyuki

doi:10.1016/j.clinbiochem.2007.01.008

Cited by 33 publications

(31 citation statements)

References 40 publications

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“…The present study demonstrated that the use of serum cystatin C, alone or with creatinine, improved expected target vancomycin trough achievement. Published pharmacokinetic analyses also suggest that cystatin C-based GFR estimates more accurately predict vancomycin clearance than creatinine clearance [25,29,30,39]. Furthermore, the current literature suggests that steady-state vancomycin troughs correlate more significantly with cystatin C-based models than creatinine-based models, largely due to reduced error among older individuals [26-28].…”

Section: Discussionmentioning

confidence: 99%

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

et al. 2014

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IntroductionSerum cystatin C can improve glomerular filtration rate (GFR) estimation over creatinine alone, but whether this translates into clinically relevant improvements in drug dosing is unclear.MethodsThis prospective cohort study enrolled adults receiving scheduled intravenous vancomycin while hospitalized at the Mayo Clinic in 2012. Vancomycin dosing was based on weight, serum creatinine with the Cockcroft-Gault equation, and clinical judgment. Cystatin C was later assayed from the stored serum used for the creatinine-based dosing. Vancomycin trough prediction models were developed by using factors available at therapy initiation. Residuals from each model were used to predict the proportion of patients who would have achieved the target trough with the model compared with that observed with usual care.ResultsOf 173 patients enrolled, only 35 (20%) had a trough vancomycin level within their target range (10 to 15 mg/L or 15 to 20 mg/L). Cystatin C-inclusive models better predicted vancomycin troughs than models based upon serum creatinine alone, although both were an improvement over usual care. The optimal model used estimated GFR by the Chronic Kidney Disease Epidemiology Collaborative (CKD-EPI) creatinine-cystatin C equation (R2 = 0.580). This model is expected to yield 54% (95% confidence interval 45% to 61%) target trough attainment (P <0.001 compared with the 20% with usual care).ConclusionsVancomycin dosing based on standard care with Cockcroft-Gault creatinine clearance yielded poor trough achievement. The developed dosing model with estimated GFR from CKD-EPIcreatinine-cystatin C could yield a 2.5-fold increase in target trough achievement compared with current clinical practice. Although this study is promising, prospective validation of this or similar cystatin C-inclusive dosing models is warranted.

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Section: Discussionmentioning

confidence: 99%

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

et al. 2014

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“…A recent meta-analysis demonstrated that the serum cystatin C concentration is superior to the serum creatinine concentration for use for the detection of an impaired GFR (7). Some studies reported that the serum cystatin C concentration is a better marker of drug clearance than the serum creatinine concentration (15,23). Recently, we have shown that the serum cystatin C concentration is a better marker for determination of the initial dose in VAN therapy.…”

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confidence: 99%

Population Pharmacokinetic Analysis of Vancomycin Using Serum Cystatin C as a Marker of Renal Function

Tanaka

Aiba

Otsuka

et al. 2010

Antimicrob Agents Chemother

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We determined the population pharmacokinetics of vancomycin (VAN) using the glomerular filtration rate (GFR) estimated from the serum cystatin C concentration. We examined the predictive performance of the trough serum VAN Vancomycin (VAN) has been widely used for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. It is mainly eliminated via the kidneys and has a narrow therapeutic range; high doses cause nephrotoxicity, particularly if it is used in combination with an aminoglycoside antibiotic (6, 28). The area under the blood concentration-time curve (AUC)/MIC is the pharmacodynamic parameter that best correlates with a successful outcome after the use of VAN (20,27). Therefore, it is believed that therapeutic drug monitoring (TDM) is appropriate for VAN therapy (3,16,18,29).The initial VAN dosage regimen is usually selected by use of a nomogram that uses the serum creatinine concentration as a marker of renal function. Our previous studies indicated that the nomogram that uses the serum creatinine concentration does not accurately predict the serum VAN trough concentration, particularly in elderly individuals (33). This is probably caused by using the serum creatinine concentration as a marker of renal function because this leads to an overestimation of the glomerular filtration rate (GFR) (17). A more accurate marker of GFR is needed for the appropriate use of VAN because renal function is one of the most important factors affecting the clearance of VAN. It has been reported that the serum cystatin C concentration is a better marker of renal function than the serum creatinine concentration (5). A recent meta-analysis demonstrated that the serum cystatin C concentration is superior to the serum creatinine concentration for use for the detection of an impaired GFR (7). Some studies reported that the serum cystatin C concentration is a better marker of drug clearance than the serum creatinine concentration (15, 23). Recently, we have shown that the serum cystatin C concentration is a better marker for determination of the initial dose in VAN therapy. In a previous study, GFR was estimated on the basis of the serum cystatin C concentration in place of the creatinine clearance, which is the parameter usually used to determine the population pharmacokinetics of VAN (32). However, a means of population pharmacokinetic analysis that uses the serum cystatin C concentration as a marker of renal function is lacking.We approached the population pharmacokinetic analysis of VAN using the serum cystatin C concentration and a onecompartment model for adult patients infected with MRSA. Covariate selection revealed that total body weight (TBW) affected the volume of distribution, whereas renal function (estimated from GFR by use of the serum cystatin C concentration) affected VAN clearance. We also compared the predictive performance of the trough serum VAN concentration for determination of the initial dose with that of the use of the nomogram and the serum creatinine concentration. MATERIA...

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“…[28][29][30][31] To the authors' knowledge, this is the first report of improved predictive ability of serum vancomycin concentration using a cystatin C-based eGFR in an SCI population. Lower values reflect improved precision.…”

Section: Discussionmentioning

confidence: 82%

Comparison of Equations With Estimate Renal Function to Predict Serum Vancomycin Concentration in Patients With Spinal Cord Injury—Does the Use of Cystatin C Improve Accuracy?

DeCarolis

Thorson

Marraffa

et al. 2014

Therapeutic Drug Monitoring

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Serum cystatin C as a better marker of vancomycin clearance than serum creatinine in elderly patients

Cited by 33 publications

References 40 publications

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study

Population Pharmacokinetic Analysis of Vancomycin Using Serum Cystatin C as a Marker of Renal Function

Comparison of Equations With Estimate Renal Function to Predict Serum Vancomycin Concentration in Patients With Spinal Cord Injury—Does the Use of Cystatin C Improve Accuracy?

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