Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin
Background: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. Objective: To determine the incidence of AKI in children receiving intravenous vancomyc...
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| Veröffentlicht in: | The Annals of pharmacotherapy 2014-12, Vol.48 (12), p.1555-1562 |
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| container_title | The Annals of pharmacotherapy |
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| creator | Sinclair, Elizabeth A. Yenokyan, Gayane McMunn, Andrea Fadrowski, Jeffrey J. Milstone, Aaron M. Lee, Carlton K. K. |
| description | Background: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. Objective: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. Methods: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to |
| doi_str_mv | 10.1177/1060028014549185 |
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K.</creator><creatorcontrib>Sinclair, Elizabeth A. ; Yenokyan, Gayane ; McMunn, Andrea ; Fadrowski, Jeffrey J. ; Milstone, Aaron M. ; Lee, Carlton K. K.</creatorcontrib><description>Background: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. Objective: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. Methods: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose. Results: Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design. Conclusions: AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.</description><identifier>ISSN: 1060-0280</identifier><identifier>EISSN: 1542-6270</identifier><identifier>DOI: 10.1177/1060028014549185</identifier><identifier>PMID: 25186624</identifier><identifier>CODEN: APHRER</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Academic Medical Centers ; Acute Kidney Injury - chemically induced ; Acute Kidney Injury - epidemiology ; Adolescent ; Anti-Bacterial Agents - adverse effects ; Biological and medical sciences ; Child ; Child, Preschool ; Female ; Hospitals, Pediatric ; Humans ; Incidence ; Infant ; Kidneys ; Male ; Medical sciences ; Nephrology. Urinary tract diseases ; Odds Ratio ; Pharmacology. Drug treatments ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Urinary system involvement in other diseases. Miscellaneous ; Vancomycin - adverse effects</subject><ispartof>The Annals of pharmacotherapy, 2014-12, Vol.48 (12), p.1555-1562</ispartof><rights>The Author(s) 2014</rights><rights>2015 INIST-CNRS</rights><rights>The Author(s) 2014.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c367t-f1dd01d93a10e5d223220ee515c03e136a6a498af99b9a16a6e1eba3222a59aa3</citedby><cites>FETCH-LOGICAL-c367t-f1dd01d93a10e5d223220ee515c03e136a6a498af99b9a16a6e1eba3222a59aa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/1060028014549185$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/1060028014549185$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28966004$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25186624$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sinclair, Elizabeth A.</creatorcontrib><creatorcontrib>Yenokyan, Gayane</creatorcontrib><creatorcontrib>McMunn, Andrea</creatorcontrib><creatorcontrib>Fadrowski, Jeffrey J.</creatorcontrib><creatorcontrib>Milstone, Aaron M.</creatorcontrib><creatorcontrib>Lee, Carlton K. K.</creatorcontrib><title>Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin</title><title>The Annals of pharmacotherapy</title><addtitle>Ann Pharmacother</addtitle><description>Background: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. Objective: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. Methods: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose. Results: Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design. Conclusions: AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.</description><subject>Academic Medical Centers</subject><subject>Acute Kidney Injury - chemically induced</subject><subject>Acute Kidney Injury - epidemiology</subject><subject>Adolescent</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Hospitals, Pediatric</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infant</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Odds Ratio</subject><subject>Pharmacology. Drug treatments</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tertiary Care Centers</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Vancomycin - adverse effects</subject><issn>1060-0280</issn><issn>1542-6270</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1LAzEQxYMoVqt3T5KLx9VMdpPdHEuxWiwI4sdxmWazbUqbLcmusP-9Ka0KgqeZ4f3eDPMIuQJ2C5Dnd8AkY7xgkIlMQSGOyBmIjCeS5-w49lFOdvqAnIewYowp4OqUDLiAQkqenZHZBHXb-EBHITTaYmsq-mHbJR3prjX0yVbO9HTqVp3vqXV0vLTryhtHX4w29tO6BX1Hp5tNr627ICc1roO5PNQheZvcv44fk9nzw3Q8miU6lXmb1FBVDCqVIjAjKs5TzpkxAoRmqYFUosRMFVgrNVcIcTRg5hgpjkIhpkPC9nu1b0Lwpi633m7Q9yWwchdM-TeYaLneW7bdfGOqH8N3EhG4OQAYNK5rH7-y4ZcrlIwrd1yy5wIuTLlqOu_iq_8f_gIG03bv</recordid><startdate>20141201</startdate><enddate>20141201</enddate><creator>Sinclair, Elizabeth A.</creator><creator>Yenokyan, Gayane</creator><creator>McMunn, Andrea</creator><creator>Fadrowski, Jeffrey J.</creator><creator>Milstone, Aaron M.</creator><creator>Lee, Carlton K. K.</creator><general>SAGE Publications</general><general>Whitney</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20141201</creationdate><title>Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin</title><author>Sinclair, Elizabeth A. ; Yenokyan, Gayane ; McMunn, Andrea ; Fadrowski, Jeffrey J. ; Milstone, Aaron M. ; Lee, Carlton K. K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c367t-f1dd01d93a10e5d223220ee515c03e136a6a498af99b9a16a6e1eba3222a59aa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Academic Medical Centers</topic><topic>Acute Kidney Injury - chemically induced</topic><topic>Acute Kidney Injury - epidemiology</topic><topic>Adolescent</topic><topic>Anti-Bacterial Agents - adverse effects</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Hospitals, Pediatric</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infant</topic><topic>Kidneys</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Odds Ratio</topic><topic>Pharmacology. Drug treatments</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tertiary Care Centers</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Vancomycin - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sinclair, Elizabeth A.</creatorcontrib><creatorcontrib>Yenokyan, Gayane</creatorcontrib><creatorcontrib>McMunn, Andrea</creatorcontrib><creatorcontrib>Fadrowski, Jeffrey J.</creatorcontrib><creatorcontrib>Milstone, Aaron M.</creatorcontrib><creatorcontrib>Lee, Carlton K. K.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>The Annals of pharmacotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sinclair, Elizabeth A.</au><au>Yenokyan, Gayane</au><au>McMunn, Andrea</au><au>Fadrowski, Jeffrey J.</au><au>Milstone, Aaron M.</au><au>Lee, Carlton K. K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin</atitle><jtitle>The Annals of pharmacotherapy</jtitle><addtitle>Ann Pharmacother</addtitle><date>2014-12-01</date><risdate>2014</risdate><volume>48</volume><issue>12</issue><spage>1555</spage><epage>1562</epage><pages>1555-1562</pages><issn>1060-0280</issn><eissn>1542-6270</eissn><coden>APHRER</coden><abstract>Background: As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited. Objective: To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI. Methods: A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose. Results: Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design. Conclusions: AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>25186624</pmid><doi>10.1177/1060028014549185</doi><tpages>8</tpages></addata></record> |
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| subjects | Academic Medical Centers Acute Kidney Injury - chemically induced Acute Kidney Injury - epidemiology Adolescent Anti-Bacterial Agents - adverse effects Biological and medical sciences Child Child, Preschool Female Hospitals, Pediatric Humans Incidence Infant Kidneys Male Medical sciences Nephrology. Urinary tract diseases Odds Ratio Pharmacology. Drug treatments Retrospective Studies Risk Factors Tertiary Care Centers Urinary system involvement in other diseases. Miscellaneous Vancomycin - adverse effects |
| title | Factors Associated With Acute Kidney Injury in Children Receiving Vancomycin |
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