Related Experiment Videos
Aminoglycoside-associated nephrotoxicity in the elderly
Anne M Baciewicz1, Denise R Sokos, Ronald I Cowan
1Department of Pharmacy Services, University Hospitals of Cleveland, Cleveland, OH, USA.
The Annals of Pharmacotherapy
|January 29, 2003
Summary
Single-dose (SD) aminoglycosides did not show a higher incidence of kidney damage in elderly patients compared to multiple-dose (MD) regimens. However, diabetes, ACE inhibitors, and SD therapy were identified as risk factors for nephrotoxicity.
Area of Science:
- Pharmacology and Nephrology
- Geriatric Medicine
- Clinical Pharmacy
Background:
- Aminoglycosides are potent antibiotics frequently used in elderly patients.
- Nephrotoxicity is a significant concern with aminoglycoside use, particularly in older adults.
- The optimal dosing strategy (single-dose vs. multiple-dose) for minimizing renal risk in this population remains debated.
Purpose of the Study:
- To compare the incidence of nephrotoxicity in elderly patients receiving single-dose (SD) versus multiple-dose (MD) aminoglycosides.
- To identify risk factors associated with aminoglycoside-induced nephrotoxicity in this demographic.
- To explore the relationship between nephrotoxicity, duration of therapy, and hospitalization length.
Main Methods:
- A prospective, observational audit was conducted at a university teaching hospital.
- Eighty-six elderly patients (> or =65 years) were stratified into SD (n=26) or MD (n=60) aminoglycoside groups.
- Nephrotoxicity was defined as a sustained increase in serum creatinine of 0.5 mg/dL over 2 days.
Main Results:
- The overall incidence of nephrotoxicity was 9.3%, with 62.5% of affected patients receiving SD therapy.
- No statistically significant difference in nephrotoxicity incidence was observed between SD and MD regimens (p = 0.051).
- Nephrotoxicity correlated significantly with longer therapy duration (p=0.044), increased hospitalization (p<0.001), diabetes mellitus (OR 15.1), ACE inhibitor use (OR 28.0), and SD therapy (OR 20.7).
Conclusions:
- The study's nephrotoxicity incidence aligns with existing literature.
- Diabetes mellitus, concurrent angiotensin-converting enzyme (ACE) inhibitor use, and single-dose aminoglycoside regimens emerged as significant risk factors for nephrotoxicity.
- A larger, randomized controlled trial is warranted to definitively ascertain differences in nephrotoxicity between SD and MD aminoglycoside therapy in the elderly.