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ICU admission, vancomycin concentration predicted acute kidney injury
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An initial vancomycin serum trough concentration of at least 15 mg/L and admission to the ICU can predict acute kidney injury among children, according to recent study results published in the Journal of the Pediatric Infectious Diseases Society.
Chad A. Knoderer, PharmD, of Butler University College of Pharmacy and Health Sciences, and colleagues examined medical records of 859 patients aged 30 days to 17 years who received vancomycin for at least 72 hours in 2007 (40 mg/kg per day) and 2010 (60 mg/kg per day) to determine acute kidney injury (AKI) and associated risk factors.
Chad A. Knoderer
"Accumulative evidence, both from our study and others, suggest that higher than optimal vancomycin exposure is associated with clinically significant acute kidney injury," Knoderer told Infectious Diseases in Children. "This suggest that regular monitoring of drug levels and renal function may be warranted for those patients who are treated with vancomycin for more than 2 to 3 days; this appears to be of even greater importance in more critically ill patients."
Overall, AKI occurred in 19.4% of patients. No significant difference was found between the two study periods — 18.8% in 2007 and 20% in 2010 (P=.636).
Admission to the ICU was significantly associated with AKI (OR=1.86; 95% CI, 1.2-2.94) as well as an initial vancomycin trough concentration of at least 15 mg/L (OR=2.18; 95% CI, 1.21-3.92).
All-cause mortality also was increased with admission to the ICU (OR=3.5; 95% CI, 1.7-7) and an initial vancomycin trough concentration of at least 15 mg/L (OR=3.4; 95% CI, 1.1-10).
“In our pediatric population, we found an initial vancomycin serum trough concentration of ≥15 mg/L and ICU admission to be independent predictors for early AKI development,” the researchers wrote. “Higher vancomycin serum trough concentrations may be associated with AKI as determined by elevated serum creatinine. Additional studies are needed to determine the longer-term clinical impact of high initial vancomycin trough concentrations. However, these findings indicate that closer therapeutic drug monitoring and renal function monitoring are clearly warranted for children who receive vancomycin therapy that extends beyond 72 hours and those with initial vancomycin trough concentrations of ≥15 mg/L.” — Amber Cox
Chad A. Knoderer, PharmD, can be reached at Butler University COPHS, 4600 Sunset Ave., Indianapolis, IN 46208; email: cknodere@butler.edu.
Disclosure: Two researchers report being PharmD candidates at Butler University College of Pharmacy and Health Sciences at the time of the study. The study was funded in part by a grant from the Butler University Holcomb Awards Committee.
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