Vancomycin associated acute kidney injury in pediatric patients

• Published in: PloS one 2018-10, Vol.13 (10), p.e0202439
• Main Authors: Moffett, Brady S, Morris, Jennifer, Kam, Charissa, Galati, Marianne, Dutta, Ankhi, Akcan-Arikan, Ayse
• Format: Article
• Language: English
• Subjects: Acetazolamide; Acute kidney failure; Antibiotics; Biology and Life Sciences; Body mass index; Chemotherapy; Children; Children & youth; Clindamycin; Complications and side effects; Critical care; Data collection; Demographics; Demography; Dopamine; Dosage and administration; Drug dosages; Drugs; Health aspects; Hospitals; Infectious diseases; Injuries; Intensive care; Kidney diseases; Kidneys; Mechanical ventilation; Median (statistics); Medical records; Medicine; Medicine and Health Sciences; Mortality; Patients; Pediatrics; Pharmacy; Population (statistical); Prevention; Risk analysis; Risk factors; Statistical analysis; Statistical methods; Systematic review; Vancomycin; Ventilation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0202439

Vancomycin associated acute kidney injury (vAKI) is a well known complication in pediatric patients. Identification and characterization of the incidence and risk factors for vAKI in the pediatric population would assist clinicians in potentially preventing or mitigating vAKI. A 6 year retrospective cohort study was designed. Patients were included if they were < 19 years of age, received vancomycin as inpatients, and had a baseline SCr and one other SCr drawn during and up to 72 hours after the discontinuation of vancomycin. Data collection included patient demographics, vancomycin doses and length of therapy, vancomycin serum concentrations, and concomitant medications. The Kidney Disease Improving Global Outcomes (KDIGO) criteria were used to characterize acute kidney injury. Descriptive statistical methods were used and ordinal logistic regression was employed to determine variables significantly associated with vAKI. A total of 7,095 patients met study criteria (55.4% male, median age 4.1 years (IQR 0.67-11.2 years)). Mechanical ventilation was used in 7.9% (n = 563) and mortality was 4.9% (n = 344). A total of 153 concomitant medications were identified. A median of 5 (IQR 3-7) SCr values were obtained and median SCr prior to vancomycin was 0.39 (IQR 0.28-0.57) mg/dL (CrCl 134±58 mL/min/1.73m2). Vancomycin was administered for a median of 2 (IQR 1-3) days (14.9±1.6 mg/kg/dose). vAKI was present in 12.2% (n = 862: KDIGO stage 1 (8.30%, n = 589), KDIGO stage 2 (1.94%, n = 138) KDIGO stage 3 (1.89%, n = 134)). Mean vancomycin serum concentration at 6-8 hours after a dose for patients with vAKI (10.7±8.9 mg/L) was significantly, but not clinically different for patients with no vAKI (7.5±6.3 mg/L). (p