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Late-Occurring Vancomycin-Associated Acute Kidney Injury in Children Receiving Prolonged Therapy
Chad A Knoderer1, Allison L Gritzman2, Kristen R Nichols3
1Butler University, Indianapolis, IN, USA cknodere@butler.edu.
Insights
Late acute kidney injury (AKI) occurred in 12.6% of children receiving prolonged vancomycin therapy. Infants under one year old were at higher risk, not vancomycin levels.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Vancomycin use in children is linked to acute kidney injury (AKI).
- Previous studies associated AKI with high vancomycin trough concentrations and long treatment durations.
- The incidence and risk factors for late-onset AKI in pediatric patients require further investigation.
Purpose of the Study:
- To determine the incidence of late AKI in children receiving vancomycin for at least 8 days.
- To identify factors associated with the development of late AKI in this pediatric population.
Main Methods:
- Retrospective study of children (30 days to 17 years) receiving intravenous vancomycin for ≥8 days (2007, 2010).
- Late AKI defined as occurring after day 7 of therapy and within 48 hours of discontinuation.
- Modified pRIFLE criteria used to assess AKI incidence.
Main Results:
- 167 children were included; 12.6% (21/167) developed late AKI.
- Concomitant use of acyclovir, amphotericin, or piperacillin-tazobactam was more frequent in patients with late AKI.
- Age less than 1 year was the sole independent predictor of late AKI (OR=4.4; 95% CI=1.3-15.4).
Conclusions:
- Late AKI affects nearly 13% of children on prolonged vancomycin.
- Vancomycin trough concentrations did not correlate with late AKI development.
- Younger age (<1 year) and co-administration of specific nephrotoxic agents are associated with increased risk for late AKI.
Background:
Acute kidney injury (AKI) in patients receiving vancomycin has been associated with trough concentrations ≥15 mg/L and longer therapy duration. The objective of this study was to determine the incidence and factors associated with late AKI in children receiving ≥8 days of vancomycin therapy.
Methods:
Children aged 30 days to 17 years who were admitted to our institution and received intravenous vancomycin for at least 8 days during January to December of 2007 and 2010 and had a suspected or proven gram-positive infection were included. Late AKI was categorized as AKI occurring after the first 7 days of therapy and within 48 hours following vancomycin discontinuation. The primary outcome was incidence of late AKI as determined by modified pRIFLE criteria.
Results:
One-hundred sixty-seven patients were included, with a median (interquartile range) age (years) and weight (kg) of 2 (1-7) and 12.5 (8.9-23.8). Late AKI was identified in 12.6% (21/167). A higher percentage of late AKI patients received concomitant treatment with intravenous acyclovir, amphotericin products, or piperacillin-tazobactam. Age <1 year was the only factor independently associated with late AKI development (odds ratio = 4.4; 95% confidence interval = 1.3-15.4).
Conclusions:
Late AKI occurred in nearly 13% of children receiving ≥8 days of vancomycin therapy. This study suggests that vancomycin trough concentrations are not associated with late AKI, but that age <1 year and concomitant administration of certain nephrotoxins may be factors associated with increased risk.
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