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Vancomycin Loading Doses and Nephrotoxicity on Medicine Teaching Services.
Phillip Wagner1,2, Jonathan Arnold1, Kathleen Sheridan3
1Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
International Journal of General Medicine
|October 13, 2022
Summary
Vancomycin loading doses are recommended for critically ill patients. This study found no significant increase in acute kidney injury (AKI) rates when using vancomycin loading doses compared to standard dosing.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Infectious Disease Society of America (IDSA) guidelines suggest vancomycin loading doses for severe infections.
- Limited research exists on the association between vancomycin loading doses and nephrotoxicity.
Purpose of the Study:
- To investigate the relationship between vancomycin loading doses and nephrotoxicity.
- To determine if vancomycin loading doses increase the 7-day acute kidney injury (AKI) rate.
Main Methods:
- Retrospective cohort study of 438 adult patients receiving vancomycin.
- Comparison of 7-day AKI rates between patients receiving loading doses versus standard doses.
- Multivariable logistic regression analysis to identify factors associated with AKI.
Main Results:
- No significant difference in 7-day AKI rates between loading dose (8.2%) and standard dose (6.3%) cohorts.
- Cohorts were similar in demographics, GFR, nephrotoxic drug exposure, and comorbidities.
- Loading dose cohort had a significantly higher BMI.
Conclusions:
- Vancomycin loading doses are not significantly associated with an increased risk of 7-day AKI.
- This finding supports the continued use of vancomycin loading doses in appropriate clinical scenarios.
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