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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Introduction:Acute Kidney Injury (AKI) describes a swift decrease in kidney function occurring over hours to days, characterized by the kidneys' failure to remove waste products from the bloodstream. This leads to dangerous complications like metabolic acidosis, fluid overload, and electrolyte imbalances, such as hyperkalemia, which can cause life-threatening arrhythmias. AKI is common in both hospital and outpatient settings, often triggered by dehydration, sepsis, or exposure to nephrotoxic...
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Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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Adverse Drug Reactions (ADRs) are potential complications that arise during pharmacotherapy, influenced by multiple risk factors. Age plays a significant role; both neonates and the elderly are at heightened risk due to their respective immature and diminished metabolic and elimination processes. Gender also impacts ADRs, with females experiencing a 1.5 to 1.7-fold greater risk than males, which may be linked to pharmacokinetic, pharmacodynamic, and hormonal differences. Notably, neonates, the...
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Multifactorial attribution for vancomycin-associated acute kidney injury.

Yu-Ling Tseng1, Chien-Chou Su2, Ching-Shiang Yang1

  • 1Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.

British Journal of Clinical Pharmacology
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Summary

Vancomycin use increases acute kidney injury (AKI) risk, especially with high concentrations. Concomitant medications like loop diuretics and certain antibiotics further modify this risk, necessitating personalized patient assessments.

Keywords:
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Area of Science:

  • Pharmacology
  • Nephrology
  • Clinical Pharmacy

Background:

  • Vancomycin is crucial for severe gram-positive infections.
  • Acute kidney injury (AKI) is a known vancomycin side effect.
  • Real-world AKI risk factors in polypharmacy are not fully understood.

Purpose of the Study:

  • Assess vancomycin exposure and AKI association.
  • Identify heterogeneous AKI risk patterns in patient subgroups.
  • Evaluate the impact of concomitant medications on vancomycin-associated AKI.

Main Methods:

  • Retrospective analysis of adult vancomycin recipients (2019-2023).
  • Logistic regression for trough concentration and AKI risk.
  • X-Learner framework for conditional average treatment effect (CATE) analysis.

Main Results:

  • 23.2% of 1611 patients developed AKI.
  • Each 1 mg/L vancomycin trough increase raised AKI odds by 8%.
  • High troughs (>15.5 mg/L) elevated AKI risk by 31% absolute.
  • Co-administration of β-lactams (piperacillin, meropenem) and loop diuretics increased AKI risk.

Conclusions:

  • Vancomycin-associated AKI risk is heterogeneous and influenced by concomitant medications.
  • Loop diuretics, piperacillin, and meropenem significantly affect vancomycin-AKI association.
  • Comprehensive risk assessment considering medication profiles is essential.