Vancomycin-associated acute kidney injury: A cross-sectional study from a single center in China

Abstract

ObjectiveThe objective of this study was to investigate the current situation of vancomycin (VAN)-associated acute kidney injury (VA-AKI) in China and identify the risk factors for VA-AKI, as well as to comprehensively examine the risk related to concurrent drug use. Further, we assessed the outcomes of patients who developed VA-AKI and the risk factors for these outcomes. Finally, we aimed to provide suggestions for improving the prevention and treatment of VA-AKI in China.MethodsWe conducted a retrospective observational study of inpatients who had been treated with VAN between January 2013 and December 2013 at Peking University First Hospital. AKI was defined as an increase in SCr of ≥0.3 mg/dl (≥26.5 μmol/l) within 48 hours or an increase to ≥1.5 times the baseline certainly or presumably within the past 7 days. VA-AKI was defined as the development of AKI during VAN therapy or within 7 days following the termination of VAN therapy. In addition, we compared patients with NO-AKI, who did not develop AKI during their hospitalization, with those with VA-AKI.ResultsOf the 934 patients treated with VAN during their hospital stay, 740 were included in this study. Among those excluded, 38.1% (74/194) were excluded because of a lack of data on serum creatinine (SCr). Among the included patients, 120 had confirmed VA-AKI, with an incidence of 16.2% (120/740). Multiple logistic regression analysis revealed that an elevated baseline estimated glomerular filtration rate (eGFR) (odds ratio [OR] = 1.009; p = 0.017) and concomitant vasopressor therapy (OR = 2.942; p = 0.009), nitrate use (OR = 2.869; p = 0.007), imipenem-cilastatin treatment (OR = 4.708; p = 0.000), and contrast medium administration (OR = 6.609 p = 0.005) were independent risk factors for VA-AKI; in addition, the receipt of orthopedic/trauma/burn surgery (OR = 0.3575; p = 0.011) and concomitant compound glycyrrhizin use (OR = 0.290; p = 0.017) were independent protective factors for VA-AKI. Multiple logistic regression analysis also demonstrated that among the patients who developed VA-AKI, coronary heart disease (CHD) (OR = 12.6; p = 0.006) and concomitant vasopressor therapy (OR = 15.4; p = 0.001) were independent risk factors for death. We also evaluated the factors influencing improvement of renal function. Multiple logistic regression analysis demonstrated that CHD (OR = 8.858, p = 0.019) and concomitant contrast medium administration (OR = 9.779, p = 0.005) were independent risk factors and that simultaneous β-blocker treatment (OR = 0.124, p = 0.001) was an independent protective factor for improvement of renal function.ConclusionPatients treated with VAN received insufficient monitoring of SCr and inadequate therapeutic drug monitoring. We recommend that hospitals increase their investment in clinical pharmacists. An elevated baseline eGFR and concomitant vasopressor therapy, nitrate use, imipenem-cilastatin treatment, and contrast medium administration were independent risk factors for VA-AKI; in addition, orthopedic/trauma/burn surgery and concom...

Vancomycin‐induced acute kidney injury in elderly Chinese patients: a single‐centre cross‐sectional study

“…The selection of diuretics in patients receiving VAN may be an important consideration. The effect of administering Chinese patent drugs concomitantly with VAN on the development of VI‐AKI was demonstrated in a study in a Chinese adult population . The present study was the first to explore the influence of Chinese patent drugs on VI‐AKI in elderly Chinese patients being treated with VAN.…”

A Risk Prediction Flowchart of Vancomycin-Induced Acute Kidney Injury to Use When Starting Vancomycin Administration: A Multicenter Retrospective Study

“…Potential risk factors for VCM-induced AKI were extracted based on the following parameters that could be evaluated on the day of initial VCM administration [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]: BMI, CCr, underlying heart disease, type of infection of infective endocarditis, and concomitant medications (non-steroidal anti-inflammatory drugs (NSAIDs), furosemide, aminoglycosides, AMPH-B, TAZ/PIPC, vasopressor drugs, nitric acid-based medicines, and tacrolimus). Vasopressor drugs included etilefrine, noradrenaline, olprinone, milrinone, dopamine, and dobutamine.…”

“…To prevent a deteriorated prognosis, early detection of nephrotoxicity is crucial for patients treated with VCM [ 6 ]. Risk factors associated with VCM-induced nephrotoxicity have been reported in several studies, and clinicians and pharmacists should pay attention to patients with these risk factors [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

Evaluation of a Multi-disciplinary Medical Model in Vancomycin Treatment in Chinese Adult Patients: A Randomized Controlled Trial

“…Although alternative drugs with relatively less nephrotoxicity are available, vancomycin, due to its effectiveness and low cost, is still the preferred and widely used drug for the treatment of MRSA. According to a multicenter study which included 103 hospitals in China, there were 357,225 cases of vancomycin prescription in the year of 2017 [26], and the incidence of VI-AKI was 16.2%-30.8% [9,27,28]. Although it has been reported that vancomycin TDM facility is available in most academic hospitals in big cities, 76.5% of the patients in these hospitals had inadequate TDM [29].…”

“…[1][2][3][4] Yet adverse drug reactions, especially vancomycin-induced acute kidney injury (VI-AKI) are still common [5][6][7][8][9], which signi cantly increase the mortality and medical expenses [10]. Our previous study showed that there was a signi cant insu ciency in the determination of serum creatinine (SCr) and the therapeutic drug monitoring (TDM) in those who were treated with vancomycin [9]. Moreover, in recent years, the minimum inhibitory concentration (MIC) of vancomycin has increased and vancomycin-resistant MRSA has appeared [11,12], which lead to a rise in vancomycin dosage and an increased risk for developing nephrotoxic AKI.…”