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Kidney Week

Abstract: TH-PO458

Therapeutic Drug Monitoring Is Associated with Better Survival in Hospitalized Nondialysis CKD Patients Treated with Vancomycin

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Lin, Yi-sheng, Taipei City Hospital, Taipei, Taiwan
  • Wu, Yuehlin, Taipei City Hospital, Taipei, Taiwan
  • Hu, Hsiao-Yun, Taipei City Hospital, Taipei, Taiwan
  • Cheng, Feng shiang, Taipei City Hospital, Taipei, Taiwan
Background

Vancomycin is widely used to treat patients infected by Gram-positive bacteria. Therapeutic drug monitoring (TDM) is routinely recommended for all patients treated with vancomycin to avoid underdoing and minimize the risk of toxicity. There are few studies, however, investigating the relationship between the TDM and clinical outcome in patient with chronic kidney disease treated with vancomycin.

Methods

We conducted a nationwide, observational population-based cohort. Claim data from Longitudinal Health Insurance Databases 2010 (LHID2010) which randomly chose one million beneficiaries from Taiwan’s National Health Insurance Research Database are used. From LHID2010, all hospitalized non-dialysis chronic kidney patients (ND-CKD) who were more than 20 years old, less than 85 year old, and received vancomycin treatment were recruited. All subjected are grouped according to whether the application of TDM or not. Cox regression was performed to assess the relationship between vancomycin TDM and mortality within 90 days.

Results

There were 3434 patients enrolled for analysis. There were 762 patients (22.2%) received TDM. There was no significant difference between these two groups with the aspect of demographic and comorbidity(gender, age ,hypertension, diabetes mellitus, heart failure, coronary artery disease, cerebrovascular accident, peripheral arterial disease, chronic obstructive pulmonary disease, liver disease, and malignancy) , except that patients in medical centers received more TMD than those in non-medical centers(27.3% vs. 19.4% ; p <0.001). Cox regression model indicated that TDM was associated with decreased risk for 90-day mortality (adjusted hazard ratio: 0.46; 95% confidence interval: 0.34-0.63; p <0.001). Moreover, age, male, heart failure, liver disease, and malignancy were also associated with increased mortality risk.

Conclusion

This is the first study to evaluate the importance of TDM in ND-CKD patients received vancomycin. In real practice, the application of TDM of vancomycin was even unexpectedly low in ND-CKD patients. Our results show ND-CKD patient with TDM of vancomycin is associated with reduced risk of mortality. The TDM of vancomycin in ND-CKD patients cannot be overemphasized.