Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Davies, Stephen; Efird, Jimmy T.; Guidry, Christopher A.; Dietch, Zachary C.; Willis, Rhett N.; Shah, Puja; Hennessy, Sara; Sawyer, Robert G.

doi:10.1089/sur.2014.198

Cited by 19 publications

(24 citation statements)

References 44 publications

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“…Thus, the high cumulative doses were likely driven by a large body weight that guided the prescriptions. Although still debatable, the epidemic of obesity might be playing a role in the incidence of this syndrome [15, 32]. On the other hand, heterogeneity in the timing of blood draws precludes drawing conclusions about a specific cut-off vancomycin trough or random level and the risk for precipitous AKI.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…In a retrospective study of 530 patients stratified by body mass index (>30 kg/m 2 ), APACHE II score greater than 21 was the only variable associated with nephrotoxicity in a regression analysis [Davies et al 2015]. There was no significant relationship between obesity and a higher risk of nephrotoxicity [Davies et al 2015;Matson et al 2015]. However, a different outcome was obtained in another study: there was fivefold greater likelihood of attaining a serum vancomycin greater than 20 mg/l in patients with exogenous obesity [Richardson et al 2015].…”

Section: Vancomycin Exposure: Synergism With Nephrotoxic Agentsmentioning

confidence: 95%

“…In addition, the increase in blood volume and cardiac output results in augmented renal delivery. Studies have examined the impact of greater drug exposure imposed by the use of unadjusted body weight to calculate the dose of vancomycin in patients with obesity [Davies et al 2015;Matson et al 2015]. Apparently influenced by the retrospective design, the results of such studies are inconsistent.…”

Section: Vancomycin Exposure: Synergism With Nephrotoxic Agentsmentioning

confidence: 99%

“…Given the multiple confounding predisposing factors, particularly in the critical care setting, proof of causality requires randomized control trials. The ethical implication of conducting such trials led to the preponderance of observational studies [Farber and Moellering, 1983;Hanrahan et al 2015;Burgess and Drew, 2014;Davies et al 2013Davies et al , 2015. With glomerular filtration as the principal mode of excretion, the initial wave of reported nephrotoxicity was attributed to the 25-30% formulation content of impurities prior to the late 1970s [Rybak et al 2009;Wood et al 1986].…”

Section: Introductionmentioning

confidence: 99%

“…Although not in a consistent fashion, data were more supportive of augmented kidney injury with the combined use of vancomycin and other nephrotoxic agents [Rybak et al 1990[Rybak et al , 2009Rostas et al 2014;Paquette et al 2015]. Buoyed by the increasing use of larger doses in clinically complex patients, more recent studies (mostly observational) suggest there may be a rising incidence of VIN [Farber and Moellering, 1983;Hanrahan et al 2015;Burgess and Drew, 2014;Davies et al 2013Davies et al , 2015.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Review of vancomycin-induced renal toxicity: an update

Bamgbola

2016

Therapeutic Advances in Endocrinology

180

145

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Abstract:In recent times the use of larger doses of vancomycin aimed at curbing the increasing incidence of resistant strains of Staphylococcus aureus has led to a wider report of acute kidney injury (AKI). Apart from biological plausibility, causality is implied by the predictive association of AKI with larger doses, longer duration, and graded plasma concentrations of vancomycin. AKI is more likely to occur with the concurrent use of nephrotoxic agents, and in critically ill patients who are susceptible to poor renal perfusion. Although most vancomycin-induced AKI cases are mild and therefore reversible, their occurrence may be associated with greater incidence of end-stage kidney disease and higher mortality rate. The strategy for its prevention includes adequate renal perfusion and therapeutic drug monitoring in high-risk individuals. In the near future, there is feasibility of renoprotective use of antioxidative substances in the delivery of vancomycin.

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The Nephrotoxicity of Vancomycin

Filippone

Kraft

Farber

2017

Clin Pharma and Therapeutics

308

274

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Vancomycin use is often associated with nephrotoxicity. It remains uncertain, however, to what extent vancomycin is directly responsible, as numerous potential risk factors for acute kidney injury frequently coexist. Herein, we critically examine available data in adult patients pertinent to this question. We review the pharmacokinetics/pharmacodynamics of vancomycin metabolism. Efficacy and safety data are discussed. The pathophysiology of vancomycin nephrotoxicity is considered. Risk factors for nephrotoxicity are enumerated, including the potential synergistic nephrotoxicity of vancomycin and piperacillin‐tazobactam. Suggestions for clinical practice and future research are given.

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Vancomycin-Associated Nephrotoxicity: The Obesity Factor

Abstract: No difference in nephrotoxicity was observed between lean and obese patients treated with vancomycin at our institution.

Cited by 19 publications

References 44 publications

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

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

Review of vancomycin-induced renal toxicity: an update

The Nephrotoxicity of Vancomycin

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