Acute Kidney Injury During Vancomycin Therapy in Critically Ill Children. Issue 6 (21st March 2013)

• Record Type: Journal Article
• Authors: Totapally, Balagangadhar R.; Machado, Jacqueline; Lee, Helen; Paredes, Ana; Raszynski, Andre
• Is Part Of: Pharmacotherapy. Volume 33:Issue 6(2013)
• Page Start: 598
• Page End: 602
• Publication Date: 2013-03-21
• Subjects: Chemotherapy -- Periodicals; Pharmacology -- Periodicals; Drug Therapy -- Periodicals; Pharmacology -- Periodicals; 615.1
• DOI: 10.1002/phar.1259
• Languages: English
• ISSNs: 0277-0008

Abstract

<abstract abstract-type="main" xml:lang="en" id="phar1259-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="phar1259-sec-0001" sec-type="section"> <title>Study Objective</title> <p>To determine the rate, risk factors, and outcome of vancomycin–associated acute kidney injury (AKI) in critically ill children.</p> </sec> <sec id="phar1259-sec-0002" sec-type="section"> <title>Design</title> <p>Retrospective cohort study.</p> </sec> <sec id="phar1259-sec-0003" sec-type="section"> <title>Setting</title> <p>Tertiary care children's hospital.</p> </sec> <sec id="phar1259-sec-0004" sec-type="section"> <title>Patients</title> <p>We reviewed the charts of children admitted to the pediatric intensive care unit during a 2‐year period who were treated with vancomycin. Courses of vancomycin interrupted by 3 days or more were counted separately. Patients were excluded if they received vancomycin treatment for fewer than 3 days, had preexisting renal failure, or had incomplete serum creatinine (S<sub>cr</sub>) data.</p> </sec> <sec id="phar1259-sec-0005" sec-type="section"> <title>Measurements and Main Results</title> <p>Demographic and laboratory data; vancomycin dose, duration, and concentrations; and concurrent use of nephrotoxic drugs were recorded. Acute kidney injury was defined as a decrease in estimated glomerular filtration rate of 50% or more from the beginning of vancomycin therapy. Descriptive statistics, step‐wise logistic regression, and repeated measures ANOVA were used to analyze the data. A total of 284 patients were included, for a total of 391 courses of vancomycin (272 children and 119 infants). The mean duration of vancomycin therapy was 6.9 ± 4.5 days. Forty nine (17.2%) patients developed AKI during 61 (15.6%) courses. Elevated S<sub>cr</sub> concentrations returned to baseline after stopping vancomycin in 53 (87%) courses. Mortality was higher in children who developed AKI (p<0.001; Fisher's exact test). Administration of nephrotoxic drugs (odds ratio 2.23, Confidence Interval 1.27–3.93) and presence of high blood urea nitrogen (BUN):S<sub>cr</sub> ratio before vancomycin therapy (p<0.05) were associated with AKI. The BUN and S<sub>cr</sub> concentrations significantly increased during vancomycin therapy and decreased after vancomycin was discontinued (p<0.05).</p> </sec> <sec id="phar1259-sec-0006" sec-type="section"> <title>Conclusions</title> <p>In critically ill children, the development of reversible AKI during vancomycin therapy is associated with administration of nephrotoxic drugs and an elevated BUN: S<sub>cr</sub> ratio.</p> </sec> </abstract>