Vancomycin-associated acute kidney injury in a large veteran population

Geeta Gyamlani, Praveen K. Potukuchi, Fridtjof Thomas, Oguz Akbilgic, Melissa Soohoo, Elani Streja, Adnan Naseer, Keiichi Sumida, Miklos Z. Molnar, Kamyar Kalantar-Zadeh, Csaba Kovesdy

Research output: Contribution to journalArticle

Abstract

Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 , we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1-1.2), 1.2 (1-1.4), and 1.4 (1.1-1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4-1.7), 1.9 (1.5-2.3), and 2.7 (2-3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

Original languageEnglish (US)
Pages (from-to)133-142
Number of pages10
JournalAmerican Journal of Nephrology
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Veterans
Vancomycin
Acute Kidney Injury
Population
Linezolid
Anti-Bacterial Agents
Daptomycin
Serum
Glomerular Filtration Rate

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Vancomycin-associated acute kidney injury in a large veteran population. / Gyamlani, Geeta; Potukuchi, Praveen K.; Thomas, Fridtjof; Akbilgic, Oguz; Soohoo, Melissa; Streja, Elani; Naseer, Adnan; Sumida, Keiichi; Molnar, Miklos Z.; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba.

In: American Journal of Nephrology, Vol. 49, No. 2, 01.02.2019, p. 133-142.

Research output: Contribution to journalArticle

Gyamlani, G, Potukuchi, PK, Thomas, F, Akbilgic, O, Soohoo, M, Streja, E, Naseer, A, Sumida, K, Molnar, MZ, Kalantar-Zadeh, K & Kovesdy, C 2019, 'Vancomycin-associated acute kidney injury in a large veteran population', American Journal of Nephrology, vol. 49, no. 2, pp. 133-142. https://doi.org/10.1159/000496484
Gyamlani, Geeta ; Potukuchi, Praveen K. ; Thomas, Fridtjof ; Akbilgic, Oguz ; Soohoo, Melissa ; Streja, Elani ; Naseer, Adnan ; Sumida, Keiichi ; Molnar, Miklos Z. ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba. / Vancomycin-associated acute kidney injury in a large veteran population. In: American Journal of Nephrology. 2019 ; Vol. 49, No. 2. pp. 133-142.
@article{281eb03b14a948b39f51c90d56dacce5,
title = "Vancomycin-associated acute kidney injury in a large veteran population",
abstract = "Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 , we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1-1.2), 1.2 (1-1.4), and 1.4 (1.1-1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4-1.7), 1.9 (1.5-2.3), and 2.7 (2-3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.",
author = "Geeta Gyamlani and Potukuchi, {Praveen K.} and Fridtjof Thomas and Oguz Akbilgic and Melissa Soohoo and Elani Streja and Adnan Naseer and Keiichi Sumida and Molnar, {Miklos Z.} and Kamyar Kalantar-Zadeh and Csaba Kovesdy",
year = "2019",
month = "2",
day = "1",
doi = "10.1159/000496484",
language = "English (US)",
volume = "49",
pages = "133--142",
journal = "American Journal of Nephrology",
issn = "0250-8095",
publisher = "S. Karger AG",
number = "2",

}

TY - JOUR

T1 - Vancomycin-associated acute kidney injury in a large veteran population

AU - Gyamlani, Geeta

AU - Potukuchi, Praveen K.

AU - Thomas, Fridtjof

AU - Akbilgic, Oguz

AU - Soohoo, Melissa

AU - Streja, Elani

AU - Naseer, Adnan

AU - Sumida, Keiichi

AU - Molnar, Miklos Z.

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 , we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1-1.2), 1.2 (1-1.4), and 1.4 (1.1-1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4-1.7), 1.9 (1.5-2.3), and 2.7 (2-3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

AB - Background: To determine the association of vancomycin with acute kidney injury (AKI) in relation to its serum concentration value and to examine the risk of AKI in patients treated with vancomycin when compared with a matched cohort of patients receiving non-glycopeptide antibiotics (linezolid/daptomycin). Methods: From a cohort of > 3 million US veterans with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m 2 , we identified 33,527 patients who received either intravenous vancomycin (n = 22,057) or non-glycopeptide antibiotics (linezolid/daptomycin, n = 11,470). We examined the association of the serum trough vancomycin level recorded within the first 48 h of administration with subsequent AKI in all patients treated with vancomycin and association of vancomycin vs. non-glycopeptide antibiotics use with the risk of incident AKI. Results: The overall multivariable adjusted ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptides were 1.1 (1.1-1.2), 1.2 (1-1.4), and 1.4 (1.1-1.7), respectively. When examined in strata divided by vancomycin trough level, the odds of AKI were similar or lower in patients receiving vancomycin compared to non-glycopeptide antibiotics as long as serum vancomycin levels were ≤20 mg/L. However, in patients with serum vancomycin levels > 20 mg/L, the ORs of AKI stages 1, 2, and 3 in patients on vancomycin vs. non-glycopeptide antibiotics were 1.5 (1.4-1.7), 1.9 (1.5-2.3), and 2.7 (2-3.5), respectively. Conclusions: Vancomycin use is associated with a higher risk of AKI when serum levels exceed > 20 mg/L.

UR - http://www.scopus.com/inward/record.url?scp=85060619017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060619017&partnerID=8YFLogxK

U2 - 10.1159/000496484

DO - 10.1159/000496484

M3 - Article

VL - 49

SP - 133

EP - 142

JO - American Journal of Nephrology

JF - American Journal of Nephrology

SN - 0250-8095

IS - 2

ER -