Abstract
AbstractReports about relationship on renal function and vancomycin exposure are conflicted and limited. Goals: To identify if high serum vancomycin levels precede changes in serum creatinine or if it is secondary to reduced glomerular filtration and to analyze associated clinical conditions. Methods: retrospective cohort study, initially of 56.555 measurements of vancomycin levels from 511 patients admitted from December 2011 to June 2012 was analyzed. Patients with uncompleted dates were excluded and the correlation analysis was performed in 127 patients that were divided into four groups based on vancomycin levels (20 mg/mL) and creatinine (1.4 mg/dL) levels. After that, 80 medical charts of these patients was reviewed for the presence of comorbidities, sepsis, acute kidney injury and use of other nephrotoxic drugs. Results: there was a significant increase in vancomycin levels, when creatinine > 1.4 mg/dL and vancomycin ≤ 20 mg/mL (Group 3) on the first measurement. It was identified there was a signi...
Highlights
Drug-induced nephrotoxicity causes one third of intra-hospital AKI cases
The objectives of this study are: to evaluate the incidence of vancomycin-induced nephrotoxicity in hospitalized patients, to identify if the high concentration of vancomycin levels precede the increase in creatinine or if they are secondary to the reduction in the glomerular filtration rate, to analyze which clinical concomitant clinical factors can influence the nephrotoxicity of vancomycin
In this study renal dysfunction occurred before the increase in vancomycin levels, which influenced the serum levels measured the following days
Summary
Drug-induced nephrotoxicity causes one third of intra-hospital AKI cases. Traditionally, drug-induced nephrotoxicity has been defined in literature as an increase of 0.3 mg/dL in the creatinine level (50%) above the base level or 50% decrease in creatinine clearance from the base level on two consecutive days, in the absence of an alternative explanation. Vancomycin’s renal depuration decreases in a linear matter with the glomerular filtration rate, which represents a half-life of 100–200 h in anuric patients (Marinho et al, 2011; Pea et al, 2009; Rybak et al, 2009a). The use of serum levels as a guide for administration intervals resulted in a safer usage of vancomycin, avoiding complications related to nephrotoxicity. As regards what was found, the results and conclusions of this study will help in the assessment of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients and to identify whether high concentrations of vancomycin precede the increase in creatinine or if they are secondary to the reduction in the glomerular filtration rate, which may be useful since there is an increasing need for higher doses of the drug. There were few reports of a direct causal relationship between toxicity and serum concentrations of vancomycin, with existing conflicts regarding which is the preceding factor, as mentioned above
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