Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment
Purpose Vancomycin (VCM) is used for the treatment of methicillin-resistant Staphylococcus aureus . Although the risk factors for VCM nephrotoxicity have been evaluated, the time course of renal function during VCM treatment is unknown. We assessed risk factors for VCM nephrotoxicity and how renal f...
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| Veröffentlicht in: | European journal of clinical pharmacology 2019-06, Vol.75 (6), p.859-866 |
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| container_title | European journal of clinical pharmacology |
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| creator | Hirai, Toshinori Hanada, Kazuhiko Kanno, Ayako Akashi, Megumi Itoh, Toshimasa |
| description | Purpose
Vancomycin (VCM) is used for the treatment of methicillin-resistant
Staphylococcus aureus
. Although the risk factors for VCM nephrotoxicity have been evaluated, the time course of renal function during VCM treatment is unknown. We assessed risk factors for VCM nephrotoxicity and how renal function varied over time.
Methods
We conducted a retrospective analysis of patients receiving intravenous VCM treatment between June 2015 and August 2017 at Tokyo Women’s Medical University, Medical Center East. VCM nephrotoxicity was defined as an increase in serum creatinine levels > 50%. We performed multivariate logistic regression analysis to assess risk factors for VCM nephrotoxicity. The time course of renal function with VCM nephrotoxicity was compared and stratified by risk factors for VCM nephrotoxicity. Clinical course of VCM nephrotoxicity and VCM trough concentration were assessed.
Results
In total, 42 (17.3%) of 243 patients developed VCM nephrotoxicity. Risk factors for VCM nephrotoxicity were VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, loop/thiazide diuretics, and non-steroidal anti-inflammatory drugs). Although time course of renal function stratified by renal hypoperfusion medications was comparable, the time course of renal function significantly deteriorated in patients with loop/thiazide diuretics. Focusing on patients continuing VCM treatment, VCM nephrotoxicity recovered in 40% of the patients and VCM trough concentration improved to 10–20 μg/mL in 75% of the patients.
Conclusions
VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications are associated with VCM nephrotoxicity. Recovery of VCM nephrotoxicity was poor compared to the improvement of VCM trough concentration. |
| doi_str_mv | 10.1007/s00228-019-02648-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2181782821</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2181782821</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-cbbdea147e8bca117300cb282f14f510ea168f7763ca781170c17eb89808fa5f3</originalsourceid><addsrcrecordid>eNp9kMtOwzAQRS0EoqXwAyyQJdaBmSStnSWqeEmVkBCsLcexaUpjF9tB9O9xaXmsWM1i7j0zOoScIlwgALsMAHnOM8Aqg3xS8oztkSGWRZ4hlLhPhgAFZpOKwYAchbAAwHEFxSEZFMAYVCUMyfyxDa_USBWdD9Q4T9-lVa5bq9ZSq1dz76L7aFUb11Tahsa201S53gdNnaFeW7mkprcqts7SpvetffmLiF7L2Gkbj8mBkcugT3ZzRJ5vrp-md9ns4fZ-ejXLVFlizFRdN1piyTSvlURkBYCqc54bLM0YIe0m3DA2KZRkPO1BIdM1rzhwI8emGJHzLXfl3VuvQxSL9G36MogcOTKeWJhS-TalvAvBayNWvu2kXwsEsZErtnJFkiu-5AqWSmc7dF93uvmpfNtMgWIbCKuNB-1_b_-D_QQtEoac</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2181782821</pqid></control><display><type>article</type><title>Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment</title><source>SpringerLink Journals - AutoHoldings</source><creator>Hirai, Toshinori ; Hanada, Kazuhiko ; Kanno, Ayako ; Akashi, Megumi ; Itoh, Toshimasa</creator><creatorcontrib>Hirai, Toshinori ; Hanada, Kazuhiko ; Kanno, Ayako ; Akashi, Megumi ; Itoh, Toshimasa</creatorcontrib><description>Purpose
Vancomycin (VCM) is used for the treatment of methicillin-resistant
Staphylococcus aureus
. Although the risk factors for VCM nephrotoxicity have been evaluated, the time course of renal function during VCM treatment is unknown. We assessed risk factors for VCM nephrotoxicity and how renal function varied over time.
Methods
We conducted a retrospective analysis of patients receiving intravenous VCM treatment between June 2015 and August 2017 at Tokyo Women’s Medical University, Medical Center East. VCM nephrotoxicity was defined as an increase in serum creatinine levels > 50%. We performed multivariate logistic regression analysis to assess risk factors for VCM nephrotoxicity. The time course of renal function with VCM nephrotoxicity was compared and stratified by risk factors for VCM nephrotoxicity. Clinical course of VCM nephrotoxicity and VCM trough concentration were assessed.
Results
In total, 42 (17.3%) of 243 patients developed VCM nephrotoxicity. Risk factors for VCM nephrotoxicity were VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, loop/thiazide diuretics, and non-steroidal anti-inflammatory drugs). Although time course of renal function stratified by renal hypoperfusion medications was comparable, the time course of renal function significantly deteriorated in patients with loop/thiazide diuretics. Focusing on patients continuing VCM treatment, VCM nephrotoxicity recovered in 40% of the patients and VCM trough concentration improved to 10–20 μg/mL in 75% of the patients.
Conclusions
VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications are associated with VCM nephrotoxicity. Recovery of VCM nephrotoxicity was poor compared to the improvement of VCM trough concentration.</description><identifier>ISSN: 0031-6970</identifier><identifier>EISSN: 1432-1041</identifier><identifier>DOI: 10.1007/s00228-019-02648-7</identifier><identifier>PMID: 30770940</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Angiotensin-converting enzyme inhibitors ; Anti-inflammatory agents ; Antibiotics ; Biomedical and Life Sciences ; Biomedicine ; Creatinine ; Diuretics ; Drug resistance ; Enzyme inhibitors ; Health care facilities ; Health risk assessment ; Inflammation ; Intravenous administration ; Methicillin ; Nonsteroidal anti-inflammatory drugs ; Patients ; Peptidyl-dipeptidase A ; Pharmacoepidemiology and Prescription ; Pharmacology/Toxicology ; Regression analysis ; Renal function ; Risk assessment ; Risk factors ; Staphylococcus infections ; Vancomycin</subject><ispartof>European journal of clinical pharmacology, 2019-06, Vol.75 (6), p.859-866</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>European Journal of Clinical Pharmacology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-cbbdea147e8bca117300cb282f14f510ea168f7763ca781170c17eb89808fa5f3</citedby><cites>FETCH-LOGICAL-c441t-cbbdea147e8bca117300cb282f14f510ea168f7763ca781170c17eb89808fa5f3</cites><orcidid>0000-0002-3898-2068</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00228-019-02648-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00228-019-02648-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30770940$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hirai, Toshinori</creatorcontrib><creatorcontrib>Hanada, Kazuhiko</creatorcontrib><creatorcontrib>Kanno, Ayako</creatorcontrib><creatorcontrib>Akashi, Megumi</creatorcontrib><creatorcontrib>Itoh, Toshimasa</creatorcontrib><title>Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment</title><title>European journal of clinical pharmacology</title><addtitle>Eur J Clin Pharmacol</addtitle><addtitle>Eur J Clin Pharmacol</addtitle><description>Purpose
Vancomycin (VCM) is used for the treatment of methicillin-resistant
Staphylococcus aureus
. Although the risk factors for VCM nephrotoxicity have been evaluated, the time course of renal function during VCM treatment is unknown. We assessed risk factors for VCM nephrotoxicity and how renal function varied over time.
Methods
We conducted a retrospective analysis of patients receiving intravenous VCM treatment between June 2015 and August 2017 at Tokyo Women’s Medical University, Medical Center East. VCM nephrotoxicity was defined as an increase in serum creatinine levels > 50%. We performed multivariate logistic regression analysis to assess risk factors for VCM nephrotoxicity. The time course of renal function with VCM nephrotoxicity was compared and stratified by risk factors for VCM nephrotoxicity. Clinical course of VCM nephrotoxicity and VCM trough concentration were assessed.
Results
In total, 42 (17.3%) of 243 patients developed VCM nephrotoxicity. Risk factors for VCM nephrotoxicity were VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, loop/thiazide diuretics, and non-steroidal anti-inflammatory drugs). Although time course of renal function stratified by renal hypoperfusion medications was comparable, the time course of renal function significantly deteriorated in patients with loop/thiazide diuretics. Focusing on patients continuing VCM treatment, VCM nephrotoxicity recovered in 40% of the patients and VCM trough concentration improved to 10–20 μg/mL in 75% of the patients.
Conclusions
VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications are associated with VCM nephrotoxicity. Recovery of VCM nephrotoxicity was poor compared to the improvement of VCM trough concentration.</description><subject>Angiotensin-converting enzyme inhibitors</subject><subject>Anti-inflammatory agents</subject><subject>Antibiotics</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Creatinine</subject><subject>Diuretics</subject><subject>Drug resistance</subject><subject>Enzyme inhibitors</subject><subject>Health care facilities</subject><subject>Health risk assessment</subject><subject>Inflammation</subject><subject>Intravenous administration</subject><subject>Methicillin</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Patients</subject><subject>Peptidyl-dipeptidase A</subject><subject>Pharmacoepidemiology and Prescription</subject><subject>Pharmacology/Toxicology</subject><subject>Regression analysis</subject><subject>Renal function</subject><subject>Risk assessment</subject><subject>Risk factors</subject><subject>Staphylococcus infections</subject><subject>Vancomycin</subject><issn>0031-6970</issn><issn>1432-1041</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kMtOwzAQRS0EoqXwAyyQJdaBmSStnSWqeEmVkBCsLcexaUpjF9tB9O9xaXmsWM1i7j0zOoScIlwgALsMAHnOM8Aqg3xS8oztkSGWRZ4hlLhPhgAFZpOKwYAchbAAwHEFxSEZFMAYVCUMyfyxDa_USBWdD9Q4T9-lVa5bq9ZSq1dz76L7aFUb11Tahsa201S53gdNnaFeW7mkprcqts7SpvetffmLiF7L2Gkbj8mBkcugT3ZzRJ5vrp-md9ns4fZ-ejXLVFlizFRdN1piyTSvlURkBYCqc54bLM0YIe0m3DA2KZRkPO1BIdM1rzhwI8emGJHzLXfl3VuvQxSL9G36MogcOTKeWJhS-TalvAvBayNWvu2kXwsEsZErtnJFkiu-5AqWSmc7dF93uvmpfNtMgWIbCKuNB-1_b_-D_QQtEoac</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Hirai, Toshinori</creator><creator>Hanada, Kazuhiko</creator><creator>Kanno, Ayako</creator><creator>Akashi, Megumi</creator><creator>Itoh, Toshimasa</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><orcidid>https://orcid.org/0000-0002-3898-2068</orcidid></search><sort><creationdate>20190601</creationdate><title>Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment</title><author>Hirai, Toshinori ; Hanada, Kazuhiko ; Kanno, Ayako ; Akashi, Megumi ; Itoh, Toshimasa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-cbbdea147e8bca117300cb282f14f510ea168f7763ca781170c17eb89808fa5f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Angiotensin-converting enzyme inhibitors</topic><topic>Anti-inflammatory agents</topic><topic>Antibiotics</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Creatinine</topic><topic>Diuretics</topic><topic>Drug resistance</topic><topic>Enzyme inhibitors</topic><topic>Health care facilities</topic><topic>Health risk assessment</topic><topic>Inflammation</topic><topic>Intravenous administration</topic><topic>Methicillin</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Patients</topic><topic>Peptidyl-dipeptidase A</topic><topic>Pharmacoepidemiology and Prescription</topic><topic>Pharmacology/Toxicology</topic><topic>Regression analysis</topic><topic>Renal function</topic><topic>Risk assessment</topic><topic>Risk factors</topic><topic>Staphylococcus infections</topic><topic>Vancomycin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hirai, Toshinori</creatorcontrib><creatorcontrib>Hanada, Kazuhiko</creatorcontrib><creatorcontrib>Kanno, Ayako</creatorcontrib><creatorcontrib>Akashi, Megumi</creatorcontrib><creatorcontrib>Itoh, Toshimasa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>European journal of clinical pharmacology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hirai, Toshinori</au><au>Hanada, Kazuhiko</au><au>Kanno, Ayako</au><au>Akashi, Megumi</au><au>Itoh, Toshimasa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment</atitle><jtitle>European journal of clinical pharmacology</jtitle><stitle>Eur J Clin Pharmacol</stitle><addtitle>Eur J Clin Pharmacol</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>75</volume><issue>6</issue><spage>859</spage><epage>866</epage><pages>859-866</pages><issn>0031-6970</issn><eissn>1432-1041</eissn><abstract>Purpose
Vancomycin (VCM) is used for the treatment of methicillin-resistant
Staphylococcus aureus
. Although the risk factors for VCM nephrotoxicity have been evaluated, the time course of renal function during VCM treatment is unknown. We assessed risk factors for VCM nephrotoxicity and how renal function varied over time.
Methods
We conducted a retrospective analysis of patients receiving intravenous VCM treatment between June 2015 and August 2017 at Tokyo Women’s Medical University, Medical Center East. VCM nephrotoxicity was defined as an increase in serum creatinine levels > 50%. We performed multivariate logistic regression analysis to assess risk factors for VCM nephrotoxicity. The time course of renal function with VCM nephrotoxicity was compared and stratified by risk factors for VCM nephrotoxicity. Clinical course of VCM nephrotoxicity and VCM trough concentration were assessed.
Results
In total, 42 (17.3%) of 243 patients developed VCM nephrotoxicity. Risk factors for VCM nephrotoxicity were VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, loop/thiazide diuretics, and non-steroidal anti-inflammatory drugs). Although time course of renal function stratified by renal hypoperfusion medications was comparable, the time course of renal function significantly deteriorated in patients with loop/thiazide diuretics. Focusing on patients continuing VCM treatment, VCM nephrotoxicity recovered in 40% of the patients and VCM trough concentration improved to 10–20 μg/mL in 75% of the patients.
Conclusions
VCM trough concentration > 20 μg/mL and concomitant use of renal hypoperfusion medications are associated with VCM nephrotoxicity. Recovery of VCM nephrotoxicity was poor compared to the improvement of VCM trough concentration.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30770940</pmid><doi>10.1007/s00228-019-02648-7</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3898-2068</orcidid></addata></record> |
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| ispartof | European journal of clinical pharmacology, 2019-06, Vol.75 (6), p.859-866 |
| issn | 0031-6970 1432-1041 |
| language | eng |
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| source | SpringerLink Journals - AutoHoldings |
| subjects | Angiotensin-converting enzyme inhibitors Anti-inflammatory agents Antibiotics Biomedical and Life Sciences Biomedicine Creatinine Diuretics Drug resistance Enzyme inhibitors Health care facilities Health risk assessment Inflammation Intravenous administration Methicillin Nonsteroidal anti-inflammatory drugs Patients Peptidyl-dipeptidase A Pharmacoepidemiology and Prescription Pharmacology/Toxicology Regression analysis Renal function Risk assessment Risk factors Staphylococcus infections Vancomycin |
| title | Risk factors for vancomycin nephrotoxicity and time course of renal function during vancomycin treatment |
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