Baseline kidney function is associated with vancomycin-induced acute kidney injury in children: a prospective nested...

Area of Science:

• Pediatric Nephrology
• Clinical Pharmacology
• Critical Care Medicine

Background:

• Children with kidney insufficiency are at risk for vancomycin-induced acute kidney injury (VIAKI).
• Limited clinical data exists on risk factors and outcomes in this vulnerable population.
• A nested case-control study was designed to investigate VIAKI in children.

Purpose of the Study:

• To evaluate the relationship between kidney insufficiency and the incidence of VIAKI in children.
• To identify risk factors associated with VIAKI in pediatric patients.
• To assess the impact of VIAKI on in-hospital mortality.

Main Methods:

• A nested case-control study involving 386 children.
• VIAKI defined by pRIFLE criteria (RIFLE-I or RIFLE-F).
• Matched cases (VIAKI) and controls (1:3 ratio) based on age, illness severity, and vancomycin dose.

Main Results:

• The incidence of VIAKI was 8.03% (31/386 children).
• Key risk factors identified: moderate kidney insufficiency (OR 8.8), vancomycin trough concentration ≥ 15 μg/mL (OR 7.7), and furosemide use (OR 24.8).
• Patients with moderate kidney insufficiency showed a significantly higher incidence of VIAKI (p < 0.001).

Conclusions:

• Moderate kidney insufficiency is a significant risk factor for VIAKI in children.
• Patients developing VIAKI experienced substantially higher in-hospital mortality rates (45.2% vs. 18.3%, p < 0.01).
• These findings highlight the need for vigilant monitoring of vancomycin therapy in children with renal impairment.