G330(P) A systematic review of the risk factors associated with vancomycin-induced acute kidney injury in children. (25th October 2020)

• Record Type: Journal Article
• Authors: Williams, C; Oni, L; McWilliam, SJ
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A119
• Page End: A119
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.285
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: Vancomycin has been suggested to contribute to acute kidney injury in adults, however few studies have addressed its role in the paediatric population. The primary aim of this paper is to review the evidence surrounding the risk factors involved in the development of paediatric acute kidney injury as a result of vancomycin administration. Methods: A systematic search was performed in November 2018 on PubMed, Web of Science and Scopus using ((AKI OR acute kidney injury OR nephrotoxic* OR renal injur* OR renal insufficiency OR kidney damage) AND (vancomycin OR vancocin) AND (p*ediatric OR child* OR infant* OR child* OR adolescen* OR neonat*)). Eligible studies were meta-analyses, clinical trials, observational studies or case series of vancomycin use in a paediatric population (0–18 years) reporting outcomes of nephrotoxicity. Results: Of 1021 records identified, sixteen retrospective cohort studies were eligible for inclusion in the review, totalling 10, 575 patients with an overall vancomycin-induced acute kidney injury (v-AKI) incidence of 13.3%. Thirteen studies considered the effect of co-administration of vancomycin with other nephrotoxins. Use of concomitant nephrotoxic medications was associated with a significantly increased risk of AKI. Co-administration of aminoglycosides, piperacillin-tazobactam, vasopressors, furosemide (and other loop diuretics), ACE inhibitors and NSAIDs were all found to be significantly associated with increased risk of AKI in at least one study. However, there was significant variation between studies. Six studies identified a serum trough vancomycin concentration ≥15 mg/L to be an independent risk factor for AKI. To a lesser extent, high dose, duration of treatment and ICU admission were also identified in some studies as risk factors for v-AKI. Conclusion: Incidence of vancomycin-induced kidney injury in children is high. Patients who are high-risk should be identified and monitored more closely in view of reducing the number of cases diagnosed. In particular, concomitant nephrotoxins should be avoided. Well-designed prospective studies are required to determine the mechanism of vancomycin-induced kidney injury and the contribution from the above risk factors.