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Vancomycin Hydrochloride as a Risk Factor for Acute Kidney Injury: A Retrospective Study

Shusuke Uekusa1, Yuki Hanai1, Shinobu Hirayama2

  • 1Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Funabashi, Japan.

Pharmacology
|August 2, 2023
PubMed
Abstract

Insights

High vancomycin (VCM) levels and concurrent use of tazobactam-piperacillin (TZP) increase the risk of acute kidney injury (AKI). Early monitoring of VCM levels within two days can help reduce AKI incidence.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Vancomycin hydrochloride (VCM) is associated with acute kidney injury (AKI), with reported incidence ranging from 5-43%.
  • VCM-induced AKI typically occurs 4-17 days after treatment initiation but can manifest earlier.
  • Identifying early risk factors for VCM-induced AKI is crucial for patient safety.

Purpose of the Study:

  • To investigate risk factors for the development of AKI within two and seven days of VCM administration.
  • To determine the incidence of early-onset VCM-induced AKI.

Main Methods:

  • A retrospective, single-center study included 287 patients receiving VCM therapy from April 2013 to December 2019.
  • AKI was diagnosed using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
  • Risk factors, including serum VCM trough concentrations and concomitant medications, were analyzed.

Main Results:

  • The incidence of VCM-induced AKI within 7 days was 10.8% (31/286), and within 2 days was 5.9% (15/252).
  • Elevated serum VCM trough concentrations (12.67 μg/mL for AKI within 2 days, 19.03 μg/mL for AKI within 7 days) were identified as a risk factor.
  • Concomitant use of tazobactam-piperacillin (TZP) was also a significant risk factor for VCM-induced AKI.

Conclusions:

  • High serum VCM trough concentrations and concurrent VCM-TZP therapy are independent risk factors for VCM-induced AKI.
  • Avoiding concomitant TZP or intensive renal function monitoring during combined therapy may mitigate AKI risk.
  • Monitoring serum VCM trough concentrations within the first two days of treatment can effectively reduce AKI incidence.
Keywords:
NephrotoxicityPharmacokineticsPiperacillin-tazobactamTherapeutic drug monitoringVancomycin

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