Elizabeth A Sinclair1, Gayane Yenokyan2, Andrea McMunn3, Jeffrey J Fadrowski4, Aaron M Milstone4, Carlton K K Lee5. 1. Texas Children's Hospital, Houston, TX, USA easincla@texaschildrens.org. 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 3. Kaiser Permanente Capitol Hill Medical Center, Washington, DC, USA. 4. Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Johns Hopkins University School of Medicine, Baltimore, MD, USA The Johns Hopkins Hospital, Baltimore, MD, USA.
Abstract
BACKGROUND: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. OBJECTIVE: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. METHODS: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose. RESULTS: Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design. CONCLUSIONS: AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.
BACKGROUND: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. OBJECTIVE: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. METHODS: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose. RESULTS: Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design. CONCLUSIONS: AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.
Authors: Geisa Cristina da Silva Alves; Samuel Dutra da Silva; Virginia Paula Frade; Danielle Rodrigues; André de Oliveira Baldoni; Whocely Victor de Castro; Cristina Sanches Journal: Eur J Clin Pharmacol Date: 2017-08-04 Impact factor: 2.953
Authors: Morgan B Slater; Andrea Gruneir; Paula A Rochon; Andrew W Howard; Gideon Koren; Christopher S Parshuram Journal: Paediatr Drugs Date: 2017-02 Impact factor: 3.022
Authors: J Chase McNeil; Eric Y Kok; Andrea R Forbes; Linda Lamberth; Kristina G Hulten; Jesus G Vallejo; Edward O Mason; Sheldon L Kaplan Journal: Pediatr Infect Dis J Date: 2016-03 Impact factor: 2.129