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Abstract: PO0030

Characterizing AKI from Vancomycin-Associated Nephrotoxicity in Adult Non-ICU Patients at an Inner City Hospital: Incidence and Predictors

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Fletcher, Gerald, Harlem Hospital Center, New York, New York, United States
  • Roberts, Levard G., Harlem Hospital Center, New York, New York, United States
  • Achi, Sai Santhoshini, Harlem Hospital Center, New York, New York, United States
  • Ferguson, Sheldon, Harlem Hospital Center, New York, New York, United States
  • Handoo, Maryam M., Harlem Hospital Center, New York, New York, United States
  • Sheppard, Richard Stephen, Harlem Hospital Center, New York, New York, United States
  • Aung, Aye M., Harlem Hospital Center, New York, New York, United States
  • Jain, Sudhanshu, Harlem Hospital Center, New York, New York, United States
  • Andrabi, Suhaib A., Harlem Hospital Center, New York, New York, United States
Background

Vancomycin is a widely used antibiotic in the in-patient setting. Concerns of vancomycin-associated nephrotoxicity(VAN) were raised due to impurities associated with the first released parenteral formulations in the 1950s. Nephrotoxicity is reported to have markedly declined with a wide variability in the incidence. There is a dearth of information on the current incidence of VAN as a cause of acute kidney injury(AKI) in adult non-ICU populations. The purpose of this study was to estimate the incidence of VAN AKI and identify risk factors of VAN for this population.

Methods

A cohort of patients admitted between January 2015 and December 2017 with the diagnosis of sepsis and who received at least 3 days of parenteral vancomycin were identified through a retrospective chart review. Exclusions were ESRD or CKD history. Our primary outcome was the occurrence of VAN AKI, defined as an increase in serum creatinine by 0.3 mg/dl or 50% above baseline after vancomycin exposure. The incidence of VAN AKI was determined and we estimated risk factors associated with VAN in a logistic regression model.

Results

587 adult patients received at least 72hours of parenteral vancomycin for the treatment of sepsis during the period. Demographics were: male 350(59.6%), female 237(40.4%) and mean age of 62.3 years. Distribution by ethnicity: non-Hispanic Blacks 71.2%, Hispanics 12.6%, non-Hispanic white 3.4% and 12.4% were other ethnicities. The incidence of VAN AKI was 15.24%. These patients had a longer hospital stay (26.8 versus 21.5 days for no VAN AKI), higher mean vancomycin trough levels, longer duration of exposure to vancomycin and a higher Charlston Comorbidity Index (3.5 versus 2.6). Independent predictors for VAN were: mean vancomycin trough level, hypertension, COPD, congestive heart failure, liver disease, severe obesity and dementia (all p values <0.05). Previous ICU admission and hypotension status did not predict VAN AKI.

Conclusion

We report an incidence of VAN AKI of 15.24% in non-ICU adult patients with no history of ESRD or CKD. Risk factors associated with the development of VAN include mean vancomycin trough level, hypertension, congestive heart failure, COPD, liver disease, severe obesity and dementia.