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Factors associated with acute kidney injury in children receiving vancomycin
Elizabeth A Sinclair1, Gayane Yenokyan2, Andrea McMunn3
1Texas Children's Hospital, Houston, TX, USA easincla@texaschildrens.org.
Insights
Higher vancomycin doses in children increase the risk of acute kidney injury (AKI). Close patient monitoring is essential, especially with increased dosing or concurrent nephrotoxic medication use.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Increasing use of higher vancomycin doses in pediatric patients raises concerns about acute kidney injury (AKI).
- Limited data exist on factors associated with vancomycin-induced AKI in children, particularly dose-related influences.
Purpose of the Study:
- To determine the incidence of AKI in children receiving intravenous vancomycin.
- To identify factors associated with increased odds of AKI in this population.
Main Methods:
- Retrospective review of 175 pediatric patients (3 months to <19 years) receiving vancomycin for ≥48 hours.
- AKI incidence assessed using Pediatric-Modified RIFLE criteria.
- Multivariate regression analyzed factors associated with AKI, focusing on vancomycin dose.
Main Results:
- 24% of patients (13.7%) developed AKI.
- Increased vancomycin dose (5 mg/kg increment) correlated with higher AKI odds (OR=1.16).
- Longer duration of therapy (OR=1.11) and concomitant nephrotoxic medication use (OR=5.02) also increased AKI risk.
Conclusions:
- Acute kidney injury (AKI) is a common complication in children treated with vancomycin.
- Higher vancomycin doses are significantly associated with increased AKI risk.
- Careful consideration of risks versus benefits, close monitoring for AKI, and assessment of concomitant medications are crucial for pediatric vancomycin therapy.
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.
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