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Vancomycin Associated Acute Kidney Injury: A Longitudinal Study in China
Pan Kunming1, Chen Can1, Chen Zhangzhang1
1Department of Pharmacy, Zhongshan Hospital Fudan University, Shanghai, China.
Frontiers in Pharmacology
|March 25, 2021
Summary
Vancomycin-associated acute kidney injury (VA-AKI) affects 14.3% of patients in China, with piperacillin-tazobactam increasing risk. Full renal recovery significantly reduces mortality in VA-AKI patients.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Vancomycin-associated acute kidney injury (VA-AKI) is a significant clinical concern.
- Clinical practices for vancomycin use in China differ from other regions, necessitating localized studies.
- Understanding VA-AKI characteristics and management in the Chinese context is crucial.
Purpose of the Study:
- To investigate the incidence and characteristics of vancomycin-associated acute kidney injury (VA-AKI) in a Chinese hospital setting.
- To identify risk factors associated with VA-AKI development and outcomes.
- To evaluate current management practices, including therapeutic drug monitoring.
Main Methods:
- A longitudinal study included hospitalized patients receiving vancomycin between January 2016 and June 2019.
- VA-AKI was defined by the development of acute kidney injury during or shortly after vancomycin therapy.
- Data on concomitant medications, therapeutic drug monitoring, and renal recovery were collected and analyzed.
Main Results:
- The incidence of VA-AKI was 14.3%, with suboptimal therapeutic drug monitoring (32.3%).
- Concomitant use of cephalosporin, carbapenems, and piperacillin-tazobactam were associated with increased VA-AKI risk.
- Piperacillin-tazobactam showed a significant association (OR 3.12, p = 0.002).
Conclusions:
- There is a need to improve serum creatinine monitoring for AKI diagnosis and standardize vancomycin therapeutic drug monitoring in China.
- Concomitant administration of piperacillin-tazobactam is a key risk factor for VA-AKI.
- Achieving full renal recovery is an independent protective factor against mortality in VA-AKI patients.
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