Evaluation of Nephrotoxicity Associated with Once-Daily Administration of Aminoglycoside

Abstract

Objective: To determine the potential risk factors associated with nephrotoxicity in patients receiving once-daily aminoglycoside (ODA) therapy. Design: Case series. Setting: Large community teaching hospital. Patients: Twenty-five patients considered nephrotoxic during ODA therapy. Main Outcome Measures: This study is a retrospective chart review of patients in whom nephrotoxicity developed during ODA therapy. Nephrotoxicity was defined as a rise in serum creatinine (SCr) concentration of 0.5 mg/dL or more above the preaminoglycoside baseline value. Patients were identified from our institutional ODA database. Based on the previously identified risk factors for aminoglycoside-associated nephrotoxicity with conventional aminoglycoside therapy published by Bertino et al., a data collection tool was developed. Collected data included demographic information, concurrently administered drugs, diagnostic agents used, and potential comorbidity risk factors. Results: Similar to what has been found in patients receiving conventional aminoglycoside regimens, numerous risk factors, such as the concomitant use of cephalosporins, loop diuretics, intravenous contrast dye, angiotensin-converting enzyme inhibitors, and nonsteroidal antiinflammatory drugs, may have been responsible for the rise in SCr observed in our study population. In addition, common comorbidity risk factors in this population were pleural effusion, pneumonia, decrease in systolic blood pressure to less than 80 mm Hg, and preexisting renal disease. Conclusions: Nephrotoxicity is the result of multifactorial processes and is not solely due to the ODA administration technique.