Applying New Diagnostic Criteria for Acute Kidney Injury To Facilitate Early Identification of Nephrotoxicity in Vancomycin-Treated Patients
Open Access
- 1 July 2011
- journal article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 55 (7), 3278-3283
- https://doi.org/10.1128/aac.00173-11
Abstract
Acute kidney injury (AKI) associated with high-dose vancomycin (VAN) therapy is a clinical concern, but no uniform diagnostic criteria exist. The AKI Network (AKIN) proposed new criteria to diagnose AKI based on abrupt changes in serum creatinine or urine output. We conducted a prospective observational study to determine the incidence and severity of AKI and associated outcomes using the AKIN criteria versus traditional definitions. Eligible patients ( n = 227) were elderly (median, 70 years) and received VAN therapy for 8 days (median). AKI occurred in 43 patients (19%) using AKIN criteria at an onset of 6 days. AKI incidence was similar for patients with a trough level of ≥15 (24%; 17/72) versus P = 0.017), had a prior AKI episode (19% [8/43] versus 7% [5/184]; P = 0.001), and received vasopressor (28% [12/43] versus 14% [25/184]; P = 0.04) and/or nephrotoxins (84% [36/43] versus 67% [123/184]; P = 0.04). Seventeen of the AKI patients met traditional criteria, of whom more patients had stage 2 and 3 AKI (76% versus 8%; P = 0.0001), dosage adjustment (41% versus 15%) and renal consultation (35% versus 12%), prolonged length of stay after AKI (11 versus 7.5 days) and died (29% versus 12%) than those diagnosed by AKIN criteria ( P value not significant). Use of AKIN criteria for AKI has the potential to improve care of VAN-treated patients by facilitating early detection of AKI and warrants confirmation in large prospective trials.This publication has 14 references indexed in Scilit:
- Vancomycin-associated nephrotoxicity: a critical appraisal of risk with high-dose therapyInternational Journal of Antimicrobial Agents, 2011
- Influence of Vancomycin on Renal Function in Critically Ill Patients after Cardiac SurgeryAnesthesiology, 2009
- Long-term Risk of Mortality and Other Adverse Outcomes After Acute Kidney Injury: A Systematic Review and Meta-analysisAmerican Journal of Kidney Diseases, 2009
- Clinical review: RIFLE and AKIN – time for reappraisalCritical Care, 2009
- Gene Expression Analysis Reveals New Possible Mechanisms of Vancomycin-Induced Nephrotoxicity and Identifies Gene Markers CandidatesToxicological Sciences, 2008
- Biomarkers of Acute Kidney InjuryAnnual Review of Pharmacology and Toxicology, 2008
- A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumoniaClinical Therapeutics, 2007
- Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injuryCritical Care, 2007
- High-Dose Vancomycin Therapy for Methicillin-Resistant Staphylococcus aureus InfectionsArchives of Internal Medicine, 2006
- Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) GroupCritical Care, 2004