An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment
Loading doses of vancomycin assist in the rapid achievement of target trough concentrations. Patients with renal dysfunction have been excluded from studies evaluating loading doses. The purpose of this study was to investigate nephrotoxicity related to initial vancomycin dose in patients with sever...
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| Veröffentlicht in: | The Journal of emergency medicine 2019-06, Vol.56 (6), p.701-708 |
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| creator | Marvin, Jennifer L. Levine, Brian J. Papas, Mia Rosini, Jamie M. |
| description | Loading doses of vancomycin assist in the rapid achievement of target trough concentrations. Patients with renal dysfunction have been excluded from studies evaluating loading doses.
The purpose of this study was to investigate nephrotoxicity related to initial vancomycin dose in patients with severe renal dysfunction.
A retrospective cohort study was approved by the Institutional Review Board of a large, academic health system. Adults were included if they received intravenous vancomycin in the emergency department and presented with creatinine clearance < 30 mL/min. Chronic dialysis patients were excluded. The primary outcome was incidence of nephrotoxicity after an initial high (>20 mg/kg) vs. low (≤20 mg/kg) dose of vancomycin. Secondary outcomes included dialysis, vancomycin concentrations, length of stay, in-hospital mortality, and a composite outcome of nephrotoxicity or dialysis.
Of the 927 patients included in the analysis, nephrotoxicity occurred in 7.2% and 13.8% of patients in the high- and low-dose groups, respectively (p |
| doi_str_mv | 10.1016/j.jemermed.2019.03.020 |
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The purpose of this study was to investigate nephrotoxicity related to initial vancomycin dose in patients with severe renal dysfunction.
A retrospective cohort study was approved by the Institutional Review Board of a large, academic health system. Adults were included if they received intravenous vancomycin in the emergency department and presented with creatinine clearance < 30 mL/min. Chronic dialysis patients were excluded. The primary outcome was incidence of nephrotoxicity after an initial high (>20 mg/kg) vs. low (≤20 mg/kg) dose of vancomycin. Secondary outcomes included dialysis, vancomycin concentrations, length of stay, in-hospital mortality, and a composite outcome of nephrotoxicity or dialysis.
Of the 927 patients included in the analysis, nephrotoxicity occurred in 7.2% and 13.8% of patients in the high- and low-dose groups, respectively (p < 0.01). Patients in the high-dose group had a reduced risk of nephrotoxicity (relative risk 0.53; 95% confidence interval 0.35–0.78). The reduction in risk remained after fitting a generalized linear model adjusting for weight, age, sex, initial serum creatinine, diabetes, and chronic kidney disease (relative risk 0.61; 95% confidence interval 0.39–0.93). Limitations of this study include its retrospective design and single-center population.
These data suggest that vancomycin loading doses do not increase nephrotoxicity compared with lower doses in patients with severe renal dysfunction. These patients should be included in future studies relating to vancomycin loading doses.</description><identifier>ISSN: 0736-4679</identifier><identifier>EISSN: 2352-5029</identifier><identifier>DOI: 10.1016/j.jemermed.2019.03.020</identifier><identifier>PMID: 31029400</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; antibiotics ; Chi-Square Distribution ; Cohort Studies ; Female ; Humans ; Incidence ; infectious disease ; Male ; medication safety ; Middle Aged ; nephrotoxicity ; Renal Dialysis - methods ; renal failure ; Renal Insufficiency, Chronic - etiology ; Renal Insufficiency, Chronic - physiopathology ; Retrospective Studies ; sepsis ; vancomycin ; Vancomycin - adverse effects ; Vancomycin - therapeutic use ; Vancomycin - toxicity</subject><ispartof>The Journal of emergency medicine, 2019-06, Vol.56 (6), p.701-708</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-b72a07dfdbf212eee5aa4f556e3435e1ccb95ea072e3bd91006dc1a960e8d70b3</citedby><cites>FETCH-LOGICAL-c368t-b72a07dfdbf212eee5aa4f556e3435e1ccb95ea072e3bd91006dc1a960e8d70b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0736467919302264$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31029400$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marvin, Jennifer L.</creatorcontrib><creatorcontrib>Levine, Brian J.</creatorcontrib><creatorcontrib>Papas, Mia</creatorcontrib><creatorcontrib>Rosini, Jamie M.</creatorcontrib><title>An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment</title><title>The Journal of emergency medicine</title><addtitle>J Emerg Med</addtitle><description>Loading doses of vancomycin assist in the rapid achievement of target trough concentrations. Patients with renal dysfunction have been excluded from studies evaluating loading doses.
The purpose of this study was to investigate nephrotoxicity related to initial vancomycin dose in patients with severe renal dysfunction.
A retrospective cohort study was approved by the Institutional Review Board of a large, academic health system. Adults were included if they received intravenous vancomycin in the emergency department and presented with creatinine clearance < 30 mL/min. Chronic dialysis patients were excluded. The primary outcome was incidence of nephrotoxicity after an initial high (>20 mg/kg) vs. low (≤20 mg/kg) dose of vancomycin. Secondary outcomes included dialysis, vancomycin concentrations, length of stay, in-hospital mortality, and a composite outcome of nephrotoxicity or dialysis.
Of the 927 patients included in the analysis, nephrotoxicity occurred in 7.2% and 13.8% of patients in the high- and low-dose groups, respectively (p < 0.01). Patients in the high-dose group had a reduced risk of nephrotoxicity (relative risk 0.53; 95% confidence interval 0.35–0.78). The reduction in risk remained after fitting a generalized linear model adjusting for weight, age, sex, initial serum creatinine, diabetes, and chronic kidney disease (relative risk 0.61; 95% confidence interval 0.39–0.93). Limitations of this study include its retrospective design and single-center population.
These data suggest that vancomycin loading doses do not increase nephrotoxicity compared with lower doses in patients with severe renal dysfunction. These patients should be included in future studies relating to vancomycin loading doses.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>antibiotics</subject><subject>Chi-Square Distribution</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>infectious disease</subject><subject>Male</subject><subject>medication safety</subject><subject>Middle Aged</subject><subject>nephrotoxicity</subject><subject>Renal Dialysis - methods</subject><subject>renal failure</subject><subject>Renal Insufficiency, Chronic - etiology</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Retrospective Studies</subject><subject>sepsis</subject><subject>vancomycin</subject><subject>Vancomycin - adverse effects</subject><subject>Vancomycin - therapeutic use</subject><subject>Vancomycin - toxicity</subject><issn>0736-4679</issn><issn>2352-5029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1vEzEQhi0EomnhL1Q-ctllbGd3szeiUiBSBFXLx9Hy2rPE0a4dbCciUn98vaQ5I1my5Hlm3vFDyDWDkgGr32_LLY4YRjQlB9aWIErg8ILMuKh4UQFvX5IZNKIu5nXTXpDLGLcArIEFe00uBMvAHGBGHpeO3h7UsFfJekd9T9MG6cppa9BpnB6-4m4TfPJ_rbbpSJd9wkAVXXtlrPtNP_r4D_upnPbjUVtH87nL89ClSH_ZtKEPeMCA9B6dGuhq3CmbN3fpDXnVqyHi2-f7ivz4dPv95kux_vZ5dbNcF1rUi1R0DVfQmN50PWccESul5n1V1SjmokKmdddWmBGOojMtA6iNZqqtARemgU5ckXenubvg_-wxJjnaqHEYlEO_j5JzVjeNaFuW0fqE6uBjDNjLXbCjCkfJQE7m5VaezcvJvAQhs_nceP2cse-m2rntrDoDH04A5p8eLAYZtZ0cGxtQJ2m8_V_GE9gGmZw</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Marvin, Jennifer L.</creator><creator>Levine, Brian J.</creator><creator>Papas, Mia</creator><creator>Rosini, Jamie M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201906</creationdate><title>An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment</title><author>Marvin, Jennifer L. ; Levine, Brian J. ; Papas, Mia ; Rosini, Jamie M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-b72a07dfdbf212eee5aa4f556e3435e1ccb95ea072e3bd91006dc1a960e8d70b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>antibiotics</topic><topic>Chi-Square Distribution</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>infectious disease</topic><topic>Male</topic><topic>medication safety</topic><topic>Middle Aged</topic><topic>nephrotoxicity</topic><topic>Renal Dialysis - methods</topic><topic>renal failure</topic><topic>Renal Insufficiency, Chronic - etiology</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Retrospective Studies</topic><topic>sepsis</topic><topic>vancomycin</topic><topic>Vancomycin - adverse effects</topic><topic>Vancomycin - therapeutic use</topic><topic>Vancomycin - toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marvin, Jennifer L.</creatorcontrib><creatorcontrib>Levine, Brian J.</creatorcontrib><creatorcontrib>Papas, Mia</creatorcontrib><creatorcontrib>Rosini, Jamie M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marvin, Jennifer L.</au><au>Levine, Brian J.</au><au>Papas, Mia</au><au>Rosini, Jamie M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment</atitle><jtitle>The Journal of emergency medicine</jtitle><addtitle>J Emerg Med</addtitle><date>2019-06</date><risdate>2019</risdate><volume>56</volume><issue>6</issue><spage>701</spage><epage>708</epage><pages>701-708</pages><issn>0736-4679</issn><eissn>2352-5029</eissn><abstract>Loading doses of vancomycin assist in the rapid achievement of target trough concentrations. Patients with renal dysfunction have been excluded from studies evaluating loading doses.
The purpose of this study was to investigate nephrotoxicity related to initial vancomycin dose in patients with severe renal dysfunction.
A retrospective cohort study was approved by the Institutional Review Board of a large, academic health system. Adults were included if they received intravenous vancomycin in the emergency department and presented with creatinine clearance < 30 mL/min. Chronic dialysis patients were excluded. The primary outcome was incidence of nephrotoxicity after an initial high (>20 mg/kg) vs. low (≤20 mg/kg) dose of vancomycin. Secondary outcomes included dialysis, vancomycin concentrations, length of stay, in-hospital mortality, and a composite outcome of nephrotoxicity or dialysis.
Of the 927 patients included in the analysis, nephrotoxicity occurred in 7.2% and 13.8% of patients in the high- and low-dose groups, respectively (p < 0.01). Patients in the high-dose group had a reduced risk of nephrotoxicity (relative risk 0.53; 95% confidence interval 0.35–0.78). The reduction in risk remained after fitting a generalized linear model adjusting for weight, age, sex, initial serum creatinine, diabetes, and chronic kidney disease (relative risk 0.61; 95% confidence interval 0.39–0.93). Limitations of this study include its retrospective design and single-center population.
These data suggest that vancomycin loading doses do not increase nephrotoxicity compared with lower doses in patients with severe renal dysfunction. These patients should be included in future studies relating to vancomycin loading doses.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31029400</pmid><doi>10.1016/j.jemermed.2019.03.020</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over antibiotics Chi-Square Distribution Cohort Studies Female Humans Incidence infectious disease Male medication safety Middle Aged nephrotoxicity Renal Dialysis - methods renal failure Renal Insufficiency, Chronic - etiology Renal Insufficiency, Chronic - physiopathology Retrospective Studies sepsis vancomycin Vancomycin - adverse effects Vancomycin - therapeutic use Vancomycin - toxicity |
| title | An Evaluation of the Incidence of Nephrotoxicity After a Loading Dose of Vancomycin in Patients With Severe Renal Impairment |
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