scholarly journals Vancomycin-Associated Acute Kidney Injury in a Large Veteran Population

2019 ◽  
Vol 49 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Geeta Gyamlani ◽  
Praveen K. Potukuchi ◽  
Fridtjof Thomas ◽  
Oguz Akbilgic ◽  
Melissa Soohoo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Estimated Glomerular Filtration Rate ◽  
Trough Level ◽  
Kidney Injury ◽  
Serum Levels ◽  
Glycopeptide Antibiotics ◽  
Serum Trough ◽  
Antibiotics Use ◽  
Vancomycin Trough ◽  
Serum Vancomycin

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.

Are Blacks at Higher Risk for Vancomycin-Related Acute Kidney Injury?

2019 ◽  
Vol 33 (5) ◽  
pp. 592-597 ◽  
Author(s):  
Mamta Sharma ◽  
Kaylin Braekevelt ◽  
Pramodini Kale-Pradhan ◽  
Susan Szpunar ◽  
Riad Khatib
Keyword(s):  
Acute Kidney Injury ◽  
Clinical Characteristics ◽  
Trough Level ◽  
Kidney Injury ◽  
Comorbid Conditions ◽  
Black Race ◽  
Source Of Infection ◽  
Vancomycin Trough ◽  
Nephrotoxic Drugs ◽  
Trough Levels

Background: Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race. Methods: Retrospective study of adult (3 ≥18 years) inpatients who were on vancomycin for 348 hours between January 2012 and December 2014. Data on demographics, comorbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected. Patients with a creatinine clearance <30 mL/min or undergoing dialysis were excluded. Results: We identified 1130 patients during the study period; 48.1% (544) were black. The overall incidence of AKI was 8.2% (10.1% blacks, 6.5% whites; P = .03). Independent predictors of AKI included black race ( P = .011); higher Charlson score ( P = .006); higher body mass index (BMI; P = .002); higher vancomycin trough level ( P < .0001); and sepsis/systemic inflammatory response syndrome (<.0001), pneumonia ( P = .001) or gastrointestinal/genitourinary ( P = .025) as the source of infection. Conclusion: The incidence of vancomycin-related AKI was higher in blacks, independent of other risk factors. Based on our study, vancomycin trough levels and renal function need to be closely monitored in blacks.

Attributable nephrotoxicity of vancomycin in critically ill patients: a marginal structural model study

2020 ◽  
Vol 75 (4) ◽  
pp. 1031-1037 ◽  
Author(s):  
Frederico Carlos de Sousa Arnaud ◽  
Alexandre Braga Libório
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Structural Model ◽  
Trough Level ◽  
Kidney Injury ◽  
Serum Levels ◽  
Marginal Structural Model ◽  
Model Study ◽  
Trough Serum ◽  
Serum Trough

Abstract Background Although vancomycin nephrotoxicity is recognizable, critically ill patients have other potential reasons for acute kidney injury (AKI) and determining its attributable nephrotoxic risk in this population can be cumbersome. Objectives To determine the risk of AKI attributable to vancomycin, controlling for baseline and time-dependent confounders. Methods Time-fixed and daily time-varying variables were extracted from a large public database. The exposures analysed were: (i) IV vancomycin; (ii) serum trough level greater than 15 and 20 mg/L; and (iii) concomitant exposure to vancomycin and piperacillin/tazobactam or other antipseudomonal β-lactams. Censoring and exposure inverse probability of treatment weighting were calculated. Marginal structural models were plotted to evaluate AKI, severe AKI (stage 2/3) and need of renal replacement therapy (RRT). Results A total of 26 865 patients were included; 19.7% received vancomycin during ICU stay. After adjusting for fixed and time-variable confounders, vancomycin exposure was associated with AKI (HR = 1.24, 95% CI = 1.09–1.38), but not with severe AKI or need of RRT (HR = 1.05, 95% CI = 0.91–1.23 and HR = 0.97, 95% CI = 0.74–1.29, respectively). A serum trough level greater than 20 mg/L was associated with AKI (HR = 1.90, 95% CI = 1.52–2.30) and severe AKI (HR = 1.69, 95% CI = 1.31–2.19), but showed no statistically significant association with need of RRT (HR = 1.48, 95% CI = 0.92–2.56). The vancomycin + piperacillin/tazobactam combination was not associated with a greater risk than vancomycin alone. Conclusions The attributable nephrotoxicity of vancomycin in critically ill patients is significantly lower than previously suggested and severe AKI is related to vancomycin only when trough serum levels are greater than 20 mg/L.

scholarly journals Incidence and risk factors of vancomycin-associated acute kidney injury in a single center: Retrospective study

2021 ◽  
Vol 5 (1) ◽  
pp. 010-016
Author(s):  
Yalamarti Tanuja ◽  
Zonoozi Shahrzad ◽  
Adu Ntoso Kwabena ◽  
Alborzi Pooneh
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Serum ◽  
Hospitalized Patients ◽  
Close Monitoring ◽  
Iodinated Contrast ◽  
Vancomycin Trough ◽  
Serum Vancomycin ◽  
Trough Levels

Background: There is enough evidence to suggest that vancomycin increases the risk of acute kidney injury (AKI) but the exact mechanism is not well understood. This study aims to understand the incidence of vancomycin-associated acute kidney injury (VA-AKI) among hospitalized patients and to identify the risk factors for VA-AKI. Methods: Patients aged 18 and above who received a minimum of 24 hours of intravenous vancomycin and who had serial creatinine measurements over a 13-month period were identified through electronic records. Patients with pre-existing AKI, or eGFR of less than 30ml/min, and patients with end stage kidney disease were excluded. Results were analyzed using t-test and Fisher’s test. A logistic regression model was used to identify the predictors for VA-AKI. Results: From the 598 patients who met the inclusion criteria, 70 developed AKI. Compared to those without AKI, patients with VA-AKI had higher mean serum vancomycin trough levels (22.6 mg/L vs. 14.6 mg/L), and a statistically significant longer duration of vancomycin use (6.7 vs. 5.2 days). Multivariate analysis revealed that serum vancomycin level of > 20 mg/L was associated with a six-fold increase in odds of VA-AKI when compared to those with vancomycin levels < 15 mg/L. The presence of hypotension, iodinated contrast use, and concomitant use of piperacillin-tazobactam were all associated with increased odds of VA-AKI. Conclusion: The incidence of VA-AKI in hospitalized patients with eGFR > 30 ml/min was 11.7%. Serum vancomycin levels of > 20 mg/L, hypotension and administration of iodinated contrast significantly increased the risk of VA-AKI. Piperacillin-tazobactam, when used with vancomycin, was noted to be an independent predictor of AKI, regardless of serum vancomycin trough levels, prompting a reevaluation of the safety of this widespread practice as empiric therapy. Close monitoring of kidney function, avoiding high serum vancomycin levels, maintaining hemodynamic stability, and avoiding unnecessary use of iodinated contrast seem to be essential for the prevention of VA-AKI.

scholarly journals Cochrane meta-analysis: teicoplanin versus vancomycin for proven or suspected infection

2011 ◽  
Vol 9 (3) ◽  
pp. 265-282 ◽  
Author(s):  
Diogo Diniz Gomes Bugano ◽  
Alexandre Biasi Cavalcanti ◽  
Anderson Roman Goncalves ◽  
Claudia Salvini de Almeida ◽  
Eliézer Silva
Keyword(s):  
Acute Kidney Injury ◽  
Adverse Events ◽  
Data Extraction ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Kidney Injury ◽  
Serum Levels ◽  
Suspected Infection ◽  
Red Man Syndrome

ABSTRACT Objective: To compare efficacy and safety of vancomycin versus teicoplanin in patients with proven or suspected infection. Methods: Data Sources: Cochrane Renal Group's Specialized Register, CENTRAL, MEDLINE, EMBASE, nephrology textbooks and review articles. Inclusion criteria: Randomized controlled trials in any language comparing teicoplanin to vancomycin for patients with proven or suspected infection. Data extraction: Two authors independently evaluated methodological quality and extracted data. Study investigators were contacted for unpublished information. A random effect model was used to estimate the pooled risk ratio (RR) with 95% confidence interval (CI). Results: A total of 24 studies (2,610 patients) were included. The drugs had similar rates of clinical cure (RR: 1.03; 95%CI: 0.98-1.08), microbiological cure (RR: 0.98; 95%CI: 0.93-1.03) and mortality (RR: 1.02; 95%CI: 0.79-1.30). Teicoplanin had lower rates of skin rash (RR: 0.57; 95%CI: 0.35-0.92), red man syndrome (RR: 0.21; 95%CI: 0.08-0.59) and total adverse events (RR: 0.73; 95%CI: 0.53-1.00). Teicoplanin reduced the risk of nephrotoxicity (RR: 0.66; 95%CI: 0.48-0.90). This effect was consistent for patients receiving aminoglycosides (RR: 0.51; 95%CI: 0.30-0.88) or having vancomycin doses corrected by serum levels (RR: 0.22; 95%CI: 0.10-0.52). There were no cases of acute kidney injury needing dialysis. Limitations: Studies lacked a standardized definition for nephrotoxicity. Conclusions: Teicoplanin and vancomycin are equally effective; however the incidence of nephrotoxicity and other adverse events was lower with teicoplanin. It may be reasonable to consider teicoplanin for patients at higher risk for acute kidney injury.

scholarly journals Vancomycin-induced nephrotoxicity in non-intensive care unit pediatric patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinhyeung Kwak ◽  
Jeong Yeon Kim ◽  
Heeyeon Cho
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Patients ◽  
Trough Level ◽  
Medical Center ◽  
Kidney Injury ◽  
Maximum Serum ◽  
Serum Trough ◽  
Youden’S Index

AbstractPrevious data suggested several risk factors for vancomycin-induced nephrotoxicity (VIN), including higher daily dose, long-term use, underlying renal disease, intensive care unit (ICU) admission, and concomitant use of nephrotoxic medications. We conducted this study to investigate the prevalence and risk factors of VIN and to estimate the cut-off serum trough level for predicting acute kidney injury (AKI) in non-ICU pediatric patients. This was a retrospective, observational, single-center study at Samsung Medical Center tertiary hospital, located in Seoul, South Korea. We reviewed the medical records of non-ICU pediatric patients, under 19 years of age with no evidence of previous renal insufficiency, who received vancomycin for more than 48 h between January 2009 and December 2018. The clinical characteristics were compared between patients with AKI and those without to identify the risk factors associated with VIN, and the cut-off value of serum trough level to predict the occurrence of VIN was calculated by the Youden’s index. Among 476 cases, 22 patients (4.62%) developed AKI. The Youden’s index indicated that a maximum serum trough level of vancomycin above 24.35 μg/mL predicted VIN. In multivariate analysis, longer hospital stay, concomitant use of piperacillin-tazobactam and serum trough level of vancomycin above 24.35 μg/mL were associated independently with VIN. Our findings suggest that concomitant use of nephrotoxic medication and higher serum trough level of vancomycin might be associated with the risk of VIN. This study suggests that measuring serum trough level of vancomycin can help clinicians prevent VIN in pediatric patients.

scholarly journals EVALUATION OF THE BEHAVIOR OF LEVELS OF HMGB1 AND IL6 AS PREDICTORS OF INFECTION, ACUTE KIDNEY INJURY AND MORTALITY IN CIRRHOTIC PATIENTS WITH VARICEAL BLEEDING

2018 ◽  
Vol 55 (4) ◽  
pp. 338-342 ◽  
Author(s):  
Eduardo Garcia VILELA ◽  
Camilla dos Santos PINHEIRO ◽  
Saulo Fernandes SATURNINO ◽  
Célio Geraldo de Oliveira GOMES ◽  
Vanuza Chagas do NASCIMENTO ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Variceal Bleeding ◽  
High Mobility ◽  
Kidney Injury ◽  
Serum Levels ◽  
Moderate Correlation ◽  
Gastroesophageal Varices ◽  
Median Serum ◽  
Class B ◽  
Cirrhotic Patients

ABSTRACT BACKGROUND: Gastroesophageal varices and associated bleeding are a major cause of morbidity and mortality in cirrhotic patients. OBJECTIVE: To evaluate the potential role of the biomarkers HMGB1 (High Mobility Group Box 1) and IL-6 (Interleukin-6) as predictors of infection, acute kidney injury and mortality in these patients. METHODS: It is a prospective, observational study that included 32 cirrhotic patients with variceal bleeding. RESULTS: The subjects’mean age was 52±5 years and 20 (62.5%) were male. The average MELD was 17.53±5 and the average MELD-Na was 20.63±6.06. Thirty patients (93.3%) patients were Child-Pugh class B or C. Infection was present in 9 subjects (28.1%), acute kidney injury was present in 6 (18.1%) and 4 (12.5%) patients died. The median serum levels of HMGB1 were 1487 pg/mL (0.1 to 8593.1) and the median serum level of IL-6 was 62.1 pg/mL (0.1 to 1102.4). The serum levels of HMGB1 and IL-6 were significantly higher in patients who developed infection, acute kidney injury and death (P<0.05). The Spearman’s correlations for HMGB1 and IL-6 were 0.794 and 0.374 for infection, 0.53 and 0.374 for acute kidney injury and 0.467 and 0.404 for death, respectively. CONCLUSION: Serum levels of HMGB1 and IL-6 were higher in patients with the three studied outcomes. HMGB1 serum levels showed a high correlation with infection and a moderate correlation with acute kidney injury and death, while IL-6 showed a moderate correlation with infection and death and a low correlation with acute kidney injury.

scholarly journals Effect of continuous furosemide infusion on outcome of acute kidney injury

2019 ◽  
Vol 35 (3) ◽  
Author(s):  
Jie Ni ◽  
Hui Jiang ◽  
Fang Wang ◽  
Long Zhang ◽  
Dujuan Sha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intravenous Infusion ◽  
Urine Output ◽  
Kidney Injury ◽  
Oxygenation Index ◽  
Serum Levels ◽  
High Dose ◽  
Clinical Effects ◽  
Continuous Intravenous Infusion ◽  
Urea Nitrogen

Objective: To evaluate the clinical effects of continuous intravenous infusion with high-dose furosemide on early acute kidney injury (AKI) complicated with acute lung edema. Methods: Ninety patients who had been treated by furosemide at routine dose for 12 hour but with unsatisfactory outcomes were selected and subjected to continuous intravenous infusion with high-dose furosemide. The dose was adjusted according to hourly urine output. Serum levels of urea nitrogen, creatinine and potassium, pH, oxygenation index and mechanical ventilation time before and 6, 12, 24, 48 and 72 hour after treatment were compared. Results: The urine outputs before and 6, 12, 24, 48 and 72 hour after treatment were (10.71±1.81), (164.52±21.42), (189.71±29.61), (181.33±23.52), (176.82±24.80) and (164.52±18.91) ml/h respectively. Compared with data before treatment, the serum levels of urea nitrogen, creatinine and potassium significantly decreased while pH and oxygenation index significantly increased after six hour of treatment (P<0.05). After treatment, the kidney functions of 80 patients (88.9%) were completely recovered, without obvious adverse reactions. Conclusion: For patients with early AKI complicated with acute pulmonary edema who cannot be cured by diuretic agent at routine dose, high-dose furosemide increases urine output and improves success rate. doi: https://doi.org/10.12669/pjms.35.3.1012 How to cite this:Ni J, Jiang H, Wang F, Zhang L, Sha D, Wang J. Effect of continuous furosemide infusion on outcome of acute kidney injury. Pak J Med Sci. 2019;35(3):---------. doi: https://doi.org/10.12669/pjms.35.3.1012 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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