Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis

Ray, Abhisekh; Haikal, Ammar; Hammoud, Kassem; Yu, Alan

doi:10.2215/cjn.05920616

Cited by 120 publications

(101 citation statements)

References 53 publications

(54 reference statements)

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“…There is significant variability in the reported incidence of vancomycin-related AKI, ranging anywhere from 5% to as high as 43% depending on the study population and baseline risk factors [12,13]. Previous studies examining the association of vancomycin with AKI relied on observations from relatively small cohorts of patients, and thus resulting in uncertainty about the causal role of vancomycin in AKI and about what strategies to use to prevent AKI in patients treated with vancomycin [14,15].…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

et al. 2019

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Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m², we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1–1.2), 1.2 (1–1.4), and 1.4 (1.1–1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4–1.7), 1.9 (1.5–2.3), and 2.7 (2–3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

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Section: Introductionmentioning

confidence: 99%

Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

et al. 2019

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“…Following the implementation of these guidelines, reports of rising incidence of VA-AKI have emerged [14-20]. Exposure to vancomycin is now being recognized as a measurable risk for AKI [21]. However, none of those reports describe specific laboratory features of AKI that could be considered unique or characteristic of VA-AKI and that are otherwise not expected to be seen in other forms of AKI.…”

Section: Introductionmentioning

confidence: 99%

Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine

Obadan

Kaushal

Alzubaidi

et al. 2018

Nephron

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Background: Vancomycin-associated (VA) acute kidney injury (AKI) is being increasingly recognized. A distinct pattern of rapid rise in serum creatinine (sCr) during VA-AKI has occasionally been observed. However, such scenarios remain underreported. Methods: We conducted an online survey at the American Society of Nephrology Communities forum and reviewed publications of VA-AKI via PubMed or Google searching for cases of precipitous AKI (those with rise in sCr ≥1.5 mg/dL/day) attributable to vancomycin. Results: We identified 12 original cases compiled from 6 different hospitals and 4 published cases (n = 16; 38% women, age 43.5 ± 16 years, weight 108 ± 23 kg, body mass index 35 ± 7 kg/m²) of precipitous AKI observed shortly after large cumulative doses of VA (8.8 ± 5 g). The median steepest 24-h rise in sCr was 2.6 mg/dL (range 1.5–3.5 mg/dL) and the slope of the initial 48-h sCr rise was greater than that of a control AKI (non-VA, n = 48) group (2.03 ± 0.1 vs. 0.62 ± 0.0 mg/dL/day; p < 0.0001). The steep rise in sCr in the VA-AKI was not accompanied by anuria. Overt rhabdomyolysis was absent in all cases. Further, in 3 precipitous VA-AKI cases, simultaneous serum cystatin C values did not rise precipitously, suggesting that the reductions in glomerular filtration rate were overestimated by the sCr increase. Conclusions: VA-AKI can manifest with a precipitous rise in sCr shortly after a high cumulative dose of vancomycin. True toxic tubular injury overrepresented by the sCr rise is postulated.

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“…Vancomycin is the most commonly prescribed antibiotic in US hospitals with recent studies finding approximately one in four patients receive vancomycin during the course of their hospital stay [49]. Among pharmacists, nephrologists and infectious diseases physicians, there is a broad range of beliefs about vancomycin's propensity to cause V-AKI [50]. Previous studies have reported V-AKI rates ranging from less than 5% to greater than 40% and a wide variety of risk factors have been implicated [19,33].…”

Section: Discussionmentioning

confidence: 99%

“…Supratherapeutic levels dramatically increased risk; however, few patients had trough levels above 20 mg/L resulting in imprecise estimates. Vancomycin is predominantly eliminated in the urine by glomerular filtration, therefore a decrease in renal function, from any etiology, will increase vancomycin serum concentrations [19,50]. In addition, changes in serum creatinine are known to lag actual renal injury.…”

Section: Discussionmentioning

confidence: 99%

A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

et al. 2020

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Background: We sought to determine the realworld incidence of and risk factors for vancomycin-associated acute kidney injury (V-AKI) in hospitalized adults with acute bacterial skin and skin structure infections (ABSSSI). Methods: Retrospective, observational, cohort study at ten U.S. medical centers between 2015 and 2019. Hospitalized patients treated with vancomycin (C 72 h) for ABSSSI and C one baseline AKI risk factor were eligible. Patients with end-stage kidney disease, on renal replacement therapy or AKI at baseline, were excluded. The primary outcome was V-AKI by the vancomycin guidelines criteria. Results: In total, 415 patients were included. V-AKI occurred in 39 (9.4%) patients. Independent risk factors for V-AKI were: chronic alcohol abuse (aOR 4.710, 95% CI 1.929-11.499), no medical insurance (aOR 3.451, 95% CI 1.310-9.090), ICU residence (aOR 4.398, 95% CI 1.676-11.541), Gram-negative coverage (aOR 2.926, 95% CI 1.158-7.392) and vancomycin duration (aOR 1.143, 95% CI 1.037-1.260). Based on infection severity and comorbidities, Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.11409432.

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Vancomycin and the Risk of AKI: A Systematic Review and Meta-Analysis

Abstract: Our findings suggest that there is a measurable risk of AKI associated with vancomycin, but the strength of the evidence is moderate. A randomized, controlled trial designed to study kidney function as an outcome would be needed to draw unequivocal conclusions.

Cited by 120 publications

References 53 publications

Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

Vancomycin-Associated Acute Kidney Injury with a Steep Rise in Serum Creatinine

A Multicenter Evaluation of Vancomycin-Associated Acute Kidney Injury in Hospitalized Patients with Acute Bacterial Skin and Skin Structure Infections

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