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Kidney Week

Abstract: TH-PO073

Precipitous AKI due to Vancomycin: Risk Factors and Clinical Outcomes

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Aliano, Danielle Nicole, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Kanduri, Swetha Rani, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Elmayan, Ardem, Ochsner Medical Center, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Ochsner Medical Center, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

A distinct form of AKI due to vancomycin (VA-AKI) characterized by a steep rise in serum creatinine (sCr) has been described, known as vancomycin-associated precipitous-AKI (VA-pAKI). However, its incidence, risk factors and associated outcomes are unknown.

Methods

We searched records of hospitalized adults ≥18 yrs who received ≥ 2 consecutive doses of IV vancomycin (2012-2021). We defined AKI by KDIGO. VA-pAKI was defined as AKI with a rise in sCr ≥1.6 mg/dL within 24 +/- 2 hrs. To eliminate confounders, we excluded those with pre-existing CKD stages 3-5, ESKD, kidney transplant, shock requiring vasopressors, rhabdomyolysis, and those with concomitant exposure to trimethoprim (blocks creatinine secretion) or to a nephrotoxin (eg, NSAIDs, aminoglycosides, etc.). We compared variables among 3 groups: no AKI, control non-precipitous VA-AKI (VA-npAKI) and VA-pAKI by ANOVA or chi square, as appropriate.

Results

A total of 36,768 patients were included. Among them, 2,428 had AKI (7%), 403 (17%) of them stage 3 AKI. Of those, 129 had VA-pAKI (overall incidence 0.4%, 5% of VA-AKI, 30% of stage 3 VA-AKI), averaging 1 VA-pAKI case per month. Median peak rise in sCr for the VA-pAKI cases was 2.0 (1.6-3.5) mg/dL/day. Median age were 58, 60 and 46 yrs for no AKI, VA-npAKI and VA-pAKI, respectively (p<0.0001). No difference in sex or race were found. Median body weight were 177, 192 and 216 lbs. for no AKI, VA-npAKI and VA-pAKI, respectively (p<0.0001). Median cumulative dose were 3.7, 4.2 and 4.8 g for no AKI, VA-npAKI and VA-pAKI, respectively (p<0.0001). Median vancomycin level were 13, 19 and 25 mcg/mL for no AKI, VA-npAKI and VA-pAKI, respectively (p<0.0001). Regarding outcomes, 2% of VA-npAKI needed dialysis compared to 12% of the VA-pAKI group (p<0.0001). Median length of hospital stay (LOS) were 8, 12 and 14 days for no AKI, VA-npAKI and VA-pAKI, respectively (p<0.0001).

Conclusion

VA-pAKI is a distinct subtype of VA-AKI associated with younger age, greater body weight, greater cumulative dose of vancomycin and higher vancomycin level. Furthermore, VA-pAKI is associated with prolonged LOS and greater need for dialysis. Mechanistic studies are required to better understand this clinical entity.