Trough Concentration Over 12.1 mg/L is a Major Risk Factor of Vancomycin-Related Nephrotoxicity in Patients With Therapeutic Drug Monitoring

Han, Hye Kyung; An, Hyungmi; Shin, Kye Chul; Shin, Donghoon; Lee, Sue Hyun; Kim, Ju Han; Cho, Sang Heon; Kang, Hye Ryun; Jang, In‐Jin; Yu, Kyung‐Sang; Lim, Kyoung Soo

doi:10.1097/ftd.0000000000000061

Cited by 21 publications

(16 citation statements)

References 17 publications

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“…It has been demonstrated that an initial trough concentration of vancomycin of ≥15 mg/l and a duration of therapy of ≥14 days are independent risk factors associated with higher rates of nephrotoxicity (27)(28)(29). A retrospective study including 1,269 cases reported that trough concentrations of >12.1 mg/l were a major risk factor for vancomycin-induced nephrotoxicity (30). In the present study, the threshold vancomycin trough and peak concentrations for nephrotoxicity were determined to be 16.08 and 30.42 mg/l, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of efficacy and nephrotoxicity during vancomycin therapy: A retrospective study in China

et al. 2019

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The aim of the present study was to investigate the predictive value of vancomycin serum concentrations regarding its efficacy and nephrotoxicity in a Chinese population and to determine a relatively safe optimal target concentration during vancomycin therapy. A total of 65 patients that received vancomycin between March 2013 and March 2018 at Shanghai 10th People's Hospital (Shanghai, China) were enrolled and their vancomycin trough and peak concentrations were monitored. Factor analysis was performed in order to exclude interaction between variables. Univariate and multivariate analyses were used to identify predictors of drug efficacy and nephrotoxicity. Receiver operating characteristic curve analysis was performed to determine the thresholds of the vancomycin trough and peak concentrations for optimal efficacy and acceptable nephrotoxicity, respectively. Among the 65 cases, treatment was deemed to be effective for 43 patients and ineffective for 22 patients. Furthermore, 20 patients fulfilled the criteria for nephrotoxicity. A total of 15 continuous variables loaded the first five factors by factor analysis (which converts large numbers of highly inter-correlated variables into a small number of comprehensive indicators that reflect a dimensionality reduction) and the factors were as follows: Inflammation, renal function, liver function, vancomycin trough and peak concentrations, and nutritional status. Univariate and multivariate analyses identified the trough concentration and peak concentration as independent variables associated with efficacy and nephrotoxicity of vancomycin, and the nutritional status was a risk factor associated with efficacy. Regarding efficacy, the critical values for the trough concentration and peak concentration were determined to be 9.02 mg/l (95.3% sensitivity and 68.2% specificity) and 23.62 mg/l (83.7% sensitivity and 59.1% specificity), respectively. The thresholds of vancomycin trough and peak concentrations for the development of nephrotoxicity were 16.08 mg/l (80.0% sensitivity and 84.4% specificity) and 30.42 mg/l (75.0% sensitivity and 73.3% specificity), respectively. In conclusion, during vancomycin therapy, the trough and peak concentrations are associated with efficacy and nephrotoxicity. Furthermore, a trough concentration between 9.02 and 16.08 mg/l and a peak concentration of 23.62-30.42 mg/l were determined to be relatively safe (the clinical trial registry no. ChiCTR-OPC-16007920).

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Section: Discussionmentioning

confidence: 99%

Evaluation of efficacy and nephrotoxicity during vancomycin therapy: A retrospective study in China

et al. 2019

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“…15,16 Han et al also reported that a trough concentration over 12.1 mg/l was a major risk factor for nephrotoxicity in patients undergoing therapeutic vancomycin monitoring. 26 The nephrotoxicity might also be a particular matter in high-dose vancomycin therapy for MRSA infections. [27][28][29] Obviously, regular monitoring of vancomycin dosing is critical for the prevention of nephrotoxicity.…”

Section: Discussionmentioning

confidence: 99%

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

Dong

Wang

et al. 2015

International Journal of Infectious Diseases

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“…The association between VT or vancomycin total daily dose and AKI has been described in several studies [4,5,[8][9][10][11][12][13][14] . However, some studies demonstrated that higher VT level of 15-20 is not more associated with AKI than lower levels [7,15,16] .…”

Section: Discussionmentioning

confidence: 99%

Vancomycin Trough and Acute Kidney Injury: A Large Retrospective, Cohort Study

Hammoud

Brimacombe

et al. 2016

Am J Nephrol

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Background: The association between vancomycin trough (VT) and acute kidney injury (AKI) at the recommended doses remains controversial. Methods: The authors conducted a retrospective, observational cohort study of 500 adult patients who received vancomycin for ≥72 h. Data collected included 2 main predictors: average VT (including only VTs before the occurrence of AKI), first VT and other possible risk factors for AKI. The baseline characteristics/variables between patients with AKI and patients with no AKI were compared. Logistic regression models were used to develop multivariate models. The authors divided the patients into 4 subgroups: (1) VT <10, (2) 10 ≤ VT < 15, (3) 15 ≤ VT < 20 and (4) VT ≥20 µg/ml. All subgroups were compared to subgroup 2 (reference group). Results: AKI occurred in 12.85% of patients while on vancomycin. The incidence of AKI in subgroups 1-4 was 8.02, 13.61, 13.70 and 31.82%, respectively, using the first VT, that is significantly higher in subgroup 4. Using average VT, AKI incidence was 5, 10.38, 19.01 and 25.58%, respectively, that is significantly higher in subgroups 3 and 4. On multivariate logistic regression, average VT, first VT, average VT >15, first VT >15, methicillin-resistant Staphylococcus aureus infection and morbid obesity were significantly associated with increased incidence of AKI. Conclusion: Clinicians should be careful when aiming for a VT >15 μg/ml as this is associated with increased incidence of AKI.

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Trough Concentration Over 12.1 mg/L is a Major Risk Factor of Vancomycin-Related Nephrotoxicity in Patients With Therapeutic Drug Monitoring

Cited by 21 publications

References 17 publications

Evaluation of efficacy and nephrotoxicity during vancomycin therapy: A retrospective study in China

Evaluation of efficacy and nephrotoxicity during vancomycin therapy: A retrospective study in China

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

Vancomycin Trough and Acute Kidney Injury: A Large Retrospective, Cohort Study

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