Vancomycin-associated acute kidney injury epidemiology in children: a systematic review

Abstract

IntroductionVancomycin is a recognised cause of drug-induced acute kidney injury (AKI).ObjectiveThe aim of this systematic review was to summarise the incidence of, and the risk factors for, vancomycin-associated AKI (v-AKI) in children.DesignA systematic search was performed in November 2020 on the search engines PubMed, Web of Science and Medline, using predefined search terms. The inclusion criteria were primary paediatric studies, intervention with vancomycin and studies that included AKI as an outcome. Study quality was assessed using the relevant Critical Appraisal Skills Programme checklist. The data are reported using descriptive statistics.Results890 studies were identified and screened with 25 studies suitable for inclusion. A cohort of 12 730 patients with v-AKI were included and the incidence of v-AKI in children was found to be 11.8% (1.6%–27.2%). The median age of the cohort was 2.5 years (range 0–23) and 57% were male patients. Risk factors that increased the likelihood of v-AKI were concomitant use of nephrotoxic medications, increased trough concentrations and, to a lesser extent, increased dose, longer duration of treatment, impaired renal function and if the patient required paediatric intensive care.ConclusionsThe incidence of v-AKI in children is significant and methods to reduce this risk should be considered. Further prospective interventional studies to understand the mechanisms of nephrotoxicity from vancomycin are needed and targeting risk factors may make vancomycin administration safer.

The association between vancomycin trough concentrations and nephrotoxicity in the paediatric intensive care unit

“…This study identified a notably higher incidence of nephrotoxicity within the investigated population compared to other studies involving pediatric cohorts.. A recent systematic review found an 11.8% rate of vancomycinrelated acute kidney injury in hospitalized children 22 . This figure is similar to that found in a Brazilian study carried out in pediatric intensive care 18 .…”

“…However, several studies have presented contradictory results regarding the relationship between the duration of vancomycin therapy and the risk of nephrotoxicity 6 . While some studies have not found a significant correlation 25,26 , others showed a more frequent tendency towards positive results 22,23 . The findings of the present study suggest that the length of exposure to vancomycin was a risk factor for the occurrence of nephrotoxicity, indicating the need to discontinue the use of the antimicrobial as soon as as safe from an infection poin of view, aiming to benefit the patient.…”

“…In this study, the classification of nephrotoxicity covered cases reported in medical records, following clinical criteria established by the PICU team, which could include indicators such as laboratory tests and reduced urine output, among others. In contrast, other studies adopted stricter criteria based on laboratory test results, such as an increase of ≥0.5 mg/dL or ≥50% in relation to the baseline serum creatinine concentration 10,20,22 .…”

Potential therapeutic effects of Chinese meteria medica in mitigating drug-induced acute kidney injury

“…Available data suggest that drugs such as antibiotics, antifungals, antivirals, chemotherapeutic agents, analgesics, radiographic contrast agents, calcium phosphatase inhibitors, bisphosphonates, proton pump inhibitors, anticonvulsants, and diuretics cause DI-AKI ( Perazella and Rosner, 2022 ). Antibiotics and antineoplastic drugs are the most frequently reported nephrotoxic drugs ( Izzedine and Perazella, 2017 ; Rey et al, 2022 ; Williams et al, 2022 ). Based on the KDIGO guideline classification, 50.2% of DI-AKI cases were in AKI stage 1% and 49.8% were in stages 2 or 3 ( Rolland et al, 2021 ).…”