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Higher doses of vancomycin linked to kidney injury in children
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Acute kidney injury was common among hospitalized children who received vancomycin, with higher doses associated with an increased risk for kidney damage, according to study data.
“Recently published Infectious Diseases Society of America treatment guidelines for methicillin-resistant Staphylococcus aureus infections recommend vancomycin 15 mg/kg/dose every 6 hours in children with serious or invasive disease, and commonly used dosing references now also recommend higher dosing,” Elizabeth A. Sinclair, PharmD, of Texas Children’s Hospital in Houston, and colleagues wrote.
Elizabeth A. Sinclair
“Though recent adult studies describe an increased incidence of vancomycin-related nephrotoxicity and identify risk factors, current data describing the incidence of and risk factors for the development of nephrotoxicity in pediatric patients are limited.”
To examine the incidence of acute kidney injury in children receiving intravenous vancomycin and to isolate factors associated with risk for kidney damage, Sinclair and colleagues performed a retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010.
The researchers included patients (n=175), aged 3 months to 18 years, with normal kidney function, receiving vancomycin for at least 48 hours. Using the Pediatric-Modified RIFLE criteria, patients were considered to have acute kidney injury if they experienced an estimated glomerular filtration rate decrease of 50% or more from baseline anytime during vancomycin treatment or up to 72 hours after concluding vancomycin.
The researchers observed that 14% of pediatric patients receiving IV vancomycin for at least 48 hours developed acute kidney injury. They found that patients with acute kidney injury received higher average total daily vancomycin doses than patients who exhibited no kidney damage. In the multiple logistic regression analysis, likelihood of acute kidney injury increased by 16% with each 5 mg/kg increase in vancomycin dose (OR=1.16; 95% CI, 1.01-1.33).
Furthermore, the researchers observed that risk for acute kidney injury increased by 11% with each additional day of treatment (OR=1.11; 95% CI, 1.01-1.22) and the concomitant use of other nephrotoxic medications (OR=5.02; 95% CI, 1.09-23.19).
“Our results bear out the difficult balancing act between ensuring the dose is high enough to successfully treat these serious and, at times, life-threatening infections against the small but real risk for kidney damage,” researcher Carlton K.K. Lee, PharmD, MPH, associate professor of pediatrics at the Johns Hopkins Children’s Center, said in a press release. “Ultimately, what we really need are new drugs that achieve the same therapeutic effect without taking a toll on the kidneys and other organs.”
Disclosure: The researchers report no relevant financial disclosures.
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