Browse > Article
http://dx.doi.org/10.24304/kjcp.2017.27.1.22

Risk Factors for Vancomycin-Associated Nephrotoxicity in Elderly Patients  

Kim, Ha Nui (Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University)
Kim, Hae Sook (Department of Pharmacy, Gangneng Asan Hospital)
Lee, Yang Hyun (Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University)
Lee, Kyeong Ju (Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University)
Shin, Seung Woo (Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University)
Park, Seon Cheol (Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital)
Lee, Yu Jeung (Department of Clinical Pharmacy, College of Pharmacy, Kangwon National University)
Publication Information
Korean Journal of Clinical Pharmacy / v.27, no.1, 2017 , pp. 22-29 More about this Journal
Abstract
Objective: Infection is very common in the elderly, so there is a high prevalence of antibiotics use among this population. Especially, due to the emergence of resistant bacteria, the use of vancomycin is growing. The purpose of this study was to evaluate risk factors associated with vancomycin-induced nephrotoxicity in elderly patients. Methods: The subjects of this study were patients over 18 years old who received intravenous vancomycin in a general hospital located in Gangneung-si, Korea between August 1, 2013 and July 31, 2015. Data collection regarding vancomycin use and baseline characteristics was conducted using computerized hospital database. Logistic regression analysis was used to identify risk factors associated with vancomycin-induced nephrotoxicity. Results: A total of 290 patients were finally included, and 191(66%) out of these patients were age 65 or older. The incidence of vancomycin-induced nephrotoxicity was 11.0%, 12.6%, and 7.0% in the all adult patients, the elderly patients, and the non-elderly patients, respectively. There were significant differences in comorbidities between patients with nephrotoxicity and patients without nephrotoxicity in the all adult patients, and there were significant differences in vancomycin duration, comorbidities, and number of nephrotoxic agents between patients with nephrotoxicity and patients without nephrotoxicity in the elderly patients. However, according to the logistic regression analysis, there was no significant risk factor that increases the incidence of vancomycin-induced nephrotoxicity in all three age groups. Conclusion: There were no differences in risk factors that increase the incidence of vancomycin-induced nephrotoxicity between all adult patients, elderly patients, and non-elderly patients. Further studies with larger sample sizes to identify risk factors associated with vancomycin-induced nephrotoxicity in the elderly to improve the outcome of pharmacotherapy are required.
Keywords
Risk factors; acute kidney injury; vancomycin; nephrotoxicity; elderly;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Reynolds PE. Structure, biochemistry and mechanism of action of glycopeptide antibiotics. Eur J Clin Microbiol Infect Dis 1989;8(11):943-50.   DOI
2 Beard Jr EL. The American Society of Health System Pharmacists. JONAS Healthc Law Ethics Regul 2001;3(3):78-9.   DOI
3 Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillinresistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52(3):e18-e55.   DOI
4 Kim D, Ahn JY, Lee CH, et al. Increasing Resistance to Extended-Spectrum Cephalosporins, Fluoroquinolone, and Carbapenem in Gram-Negative Bacilli and the Emergence of Carbapenem Non-Susceptibility in Klebsiella pneumoniae: Analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) Data From 2013 to 2015. Ann Lab Med 2017;37(3):231-9.   DOI
5 Patel R, Gallagher JC. Vancomycin-resistant enterococcal bacteremia pharmacotherapy. Ann Pharmacother 2015;49(1):69-85.   DOI
6 Lodise TP, Lomaestro B, Graves J, et al. Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Antimicrob Agents Chemother 2008;52(4):1330-6.   DOI
7 Lodise TP, Patel N, Lomaestro BM, et al. Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients. Clin Infect Dis 2009;49(4):507-14.   DOI
8 Hidayat LK, Hsu DI, Quist R, et al. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006;166(19):2138-44.   DOI
9 Fangtang JT. Vancomycin: predictive risk factors for nephrotoxicity and implication for monitoring. 1996.
10 Minejima E, Choi J, Beringer P, et al. Applying new diagnostic criteria for acute kidney injury to facilitate early identification of nephrotoxicity in vancomycin-treated patients. Antimicrob Agents Chemother 2011;55(7):3278-83.   DOI
11 Elyasi S, Khalili H, Dashti-Khavidaki S, et al. Vancomycin-induced nephrotoxicity: mechanism, incidence, risk factors and special populations. A literature review. Eur J Clin Pharmacol 2012;68(9):1243-55.   DOI
12 Kirst HA, Thompson DG, Nicas TI. Historical yearly usage of vancomycin. Antimicrob Agents Chemother 1998;42(5):1303-4.
13 Horey A, Mergenhagen KA, Mattappallil A. The relationship of nephrotoxicity to vancomycin trough serum concentrations in a veteran's population: a retrospective analysis. Ann Pharmacother 2012;46(11): 1477-83.   DOI
14 Meaney CJ, Hynicka LM, Tsoukleris MG. Vancomycin-Associated Nephrotoxicity in Adult Medicine Patients: Incidence, Outcomes, and Risk Factors. Pharmacotherapy 2014;34(7):653-61.   DOI
15 Cano EL, Haque NZ, Welch VL, et al. Incidence of nephrotoxicity and association with vancomycin use in intensive care unit patients with pneumonia: retrospective analysis of the IMPACT-HAP Database. Clin Ther 2012;34(1):149-57.   DOI
16 Perazella MA. Drug-induced nephropathy: an update. Expert Opin Drug Saf 2005;4(4):689-706.   DOI
17 Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002;39(5):930-6.   DOI
18 Toyoguchi T, Takahashi S, Hosoya J, et al. Nephrotoxicity of vancomycin and drug interaction study with cilastatin in rabbits. Antimicrob Agents Chemother 1997;41(9):1985-90.
19 Dieterich C, Puey A, Lyn S, et al. Gene expression analysis reveals new possible mechanisms of vancomycin-induced nephrotoxicity and identifies gene markers candidates. Toxicol Sci 2009;107(1):258-69.   DOI
20 Nishino Y, Takemura S, Minamiyama Y, et al. Targeting superoxide dismutase to renal proximal tubule cells attenuates vancomycininduced nephrotoxicity in rats. Free Radic Res 2003;37(4):373-9.   DOI
21 Fanos V, Cataldi L. Renal transport of antibiotics and nephrotoxicity: a review. J Chemother 2001;13(5):461-72.   DOI
22 Carreno JJ, Jaworski A, Kenney RM, et al. Comparative incidence of nephrotoxicity by age group among adult patients receiving vancomycin. Infect Dis Ther 2013;2(2):201-8.   DOI
23 Vance-Bryan K, Rotschafer JC, Gilliland SS, et al. A comparative assessment of vancomycin-associated nephrotoxicity in the young versus the elderly hospitalized patient. J Antimicrob Chemother 1994; 33(4): 811-21.   DOI
24 Hidayat LK, Hsu DI, Quist R, et al. High-dose vancomycin therapy for methicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med 2006;166(19):2138-44.   DOI
25 Farber BF, Moellering RC, Jr. Retrospective study of the toxicity of preparations of vancomycin from 1974 to 1981. Antimicrob Agents Chemother 1983;23(1):138-41.   DOI
26 Perazella MA. Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol 2009;4(7):1275-83.   DOI
27 Humes HD. Aminoglycoside nephrotoxicity. Kidney Int 1988;33(4):900-11.   DOI
28 Kobori H, Nangaku M, Navar LG, et al. The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease. Pharmacol Rev 2007;59(3):251-87.   DOI
29 Bosso JA, Nappi J, Rudisill C, et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. Antimicrob Agents Chemother 2011;55(12):5475-9.   DOI
30 Cupples WA, Braam B. Assessment of renal autoregulation. Am J Physiol Renal Physiol 2007;292(4):F1105-F23.   DOI
31 Rostas SE, Kubiak DW, Calderwood MS. High-dose intravenous vancomycin therapy and the risk of nephrotoxicity. Clin Ther 2014; 36(7):1098-101.   DOI
32 Han HK, An H, Shin KH, et al. Trough concentration over 12.1 mg/L is a major risk factor of vancomycin-related nephrotoxicity in patients with therapeutic drug monitoring. Ther Drug Monit 2014;36(5):606-11.   DOI
33 Rahman M, Shad F, Smith MC. Acute kidney injury: a guide to diagnosis and management. Am Fam Physician 2012;86(7):631-9.
34 Van Hal S, Paterson D, Lodise T. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother 2013;57(2):734-44.   DOI
35 Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004;57(1):6-14.   DOI
36 Jackson MM, Fierer J. Infections end infection risk in residents of longterm care facilities: A review of the literature, 1970-1994. Am J Infect Control 1985;13(2):63-77.   DOI
37 Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sexspecific mortality in 187 countries, 1970-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2013;380(9859): 2071-94.   DOI
38 Yoshikawa TT, Norman DC, Grahn D. Infections in the aging population. J Am Geriatr Soc 1985;33(7):496-503.   DOI
39 Beeson P. Alleged susceptibility of the elderly to infection. Yale J Biol Med 1985;58(2):71.
40 Berg RL, Cassells JS. The second fifty years: Promoting health and preventing disability: National Academy Press; 1990.
41 Walsh C. Antibiotics: American Society of Microbiology; 2003.