Kidney Week

Abstract: FR-PO080

Vancomycin-Associated AKI

Session Information

• AKI Clinical: Predictors
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Gyamlani, Geeta G., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Geeta G. Gyamlani,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Akbilgic, Oguz, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Oguz Akbilgic,

• Soohoo, Melissa, University of California Irvine, School of Medicine, Orange, California, United States

Melissa Soohoo,

• Streja, Elani, University of California Irvine, School of Medicine, Orange, California, United States

Elani Streja,

• Sumida, Keiichi, Nephrology Center, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan

Keiichi Sumida,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Vancomycin is a tricyclic glycopeptide antibiotic that is currently the mainstay of therapy for serious infections due to methicillin-resistant staph aureus. Data on the nephrotoxic potential of this agent is still highly controversial and based on small studies and meta-analyses.

Methods

From a nationally representative cohort of >3.5 million US veterans with baseline eGFR ≥60 ml/min/1.73m², we identified 40,059 patients who received either intravenous vancomycin (N=24,461) or nonglycopeptide antibiotics (linezolid/daptomycin, N=15,598). We matched patients in the two groups by propensity scores calculated from patient demographics, comorbidities, baseline eGFR and mean arterial pressure, and nephrotoxic medication exposure. Associations of vancomycin vs. nonglycopeptides with the risk of incident AKI by AKIN stages was assessed in logistic regressions.

Results

Among 27,964 propensity-matched patients (13,982 in both groups), the mean age was 66±11 years and the mean baseline eGFR was 72 ml/min/1.73m², 97% were male, 20% African-American, 51% diabetic, 27% had CHF and 8% received vasopressors. Baseline characteristics were identical in patients receiving vancomycin and nonglycopeptides. There were a total of 2,656 (19%) AKI events in the vancomycin group and 2,814 (20%) in the nonglycopeptide group. AKI stage 1 was less common, but stage 3 was more common among patients on vancomycin (Figure). The odds ratios of AKI stages 1, 2 and 3 in patients on vancomycin vs. nonglycopeptides were 0.83 (0.78-0.89), 1.02 (0.90-1.15) and 1.71 (1.44-2.03), respectively.

Conclusion

Vancomycin use is associated with a higher risk of severe AKI.

Funding

• NIDDK Support