Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

William B. Hays, Emma Tillman

Research output: Contribution to journalArticle

Abstract

Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P =.006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P =.012) and concurrent vasopressor (55% vs 23%, P =.029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P =.021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

Original languageEnglish (US)
JournalJournal of Pharmacy Practice
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Vancomycin
Acute Kidney Injury
Critical Illness
Young Adult
Incidence
Vasoconstrictor Agents
Population
Intensive Care Units
Creatinine
Pediatrics

Keywords

  • adolescent medicine
  • critical care
  • nephrotoxicity
  • pharmacokinetics
  • vancomycin

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

@article{c390bd3a9fbf4dc585fe54d395986faf,
title = "Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients",
abstract = "Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50{\%} from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P =.006), percentage of patients with concurrent nephrotoxic medication (95{\%} vs 60{\%}, P =.012) and concurrent vasopressor (55{\%} vs 23{\%}, P =.029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35{\%} vs 6.7{\%}, P =.021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40{\%} of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.",
keywords = "adolescent medicine, critical care, nephrotoxicity, pharmacokinetics, vancomycin",
author = "Hays, {William B.} and Emma Tillman",
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doi = "10.1177/0897190019829652",
language = "English (US)",
journal = "Journal of Pharmacy Practice",
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T1 - Vancomycin-Associated Acute Kidney Injury in Critically Ill Adolescent and Young Adult Patients

AU - Hays, William B.

AU - Tillman, Emma

PY - 2019/1/1

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N2 - Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P =.006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P =.012) and concurrent vasopressor (55% vs 23%, P =.029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P =.021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

AB - Background: Risk factors for the development of vancomycin-associated acute kidney injury (AKI) have been evaluated in both pediatric and adult populations; however, no previous studies exist evaluating this in the critically ill adolescent and young adult patients. Objective: Identify the incidence of AKI and examine risk factors for the development of AKI in critically ill adolescents and young adults on vancomycin. Methods: This retrospective review evaluated the incidence of AKI in patients 15 to 25 years of age who received vancomycin, while admitted to an intensive care unit. Acute kidney injury in this population was defined as an increase in serum creatinine by 0.5 mg/dL or 50% from baseline. Patients who developed AKI were evaluated for specific risk factors compared to those who did not develop AKI. Results: A total of 50 patients (20 developed AKI) were included in the study. There was no difference in vancomycin daily dose or duration of vancomycin therapy. Maximum vancomycin trough (31.15 mg/dL vs 12.5 mg/dL, P =.006), percentage of patients with concurrent nephrotoxic medication (95% vs 60%, P =.012) and concurrent vasopressor (55% vs 23%, P =.029) were higher in those who developed AKI. Percentage of patients who underwent a procedure while on vancomycin (35% vs 6.7%, P =.021) was also higher within the AKI group. Conclusions: Vancomycin-associated AKI occurred in 40% of critically ill adolescent and young adult patients. These patients may be more likely to develop vancomycin-associated AKI if they had undergone a procedure, as well as in the presence of high vancomycin trough levels, concurrent nephrotoxic agents, and concurrent vasopressor therapy.

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