Are Blacks at Higher Risk for Vancomycin-Related Acute Kidney Injury?

Abstract

Background:

Black individuals have a higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than whites. Vancomycin has a potential for nephrotoxicity. The objective of this study was to determine whether the incidence of AKI among patients being treated with vancomycin differs by race.

Methods:

Retrospective study of adult (³ ≥18 years) inpatients who were on vancomycin for ³48 hours between January 2012 and December 2014. Data on demographics, comorbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected. Patients with a creatinine clearance <30 mL/min or undergoing dialysis were excluded.

Results:

We identified 1130 patients during the study period; 48.1% (544) were black. The overall incidence of AKI was 8.2% (10.1% blacks, 6.5% whites; P = .03). Independent predictors of AKI included black race (P = .011); higher Charlson score (P = .006); higher body mass index (BMI; P = .002); higher vancomycin trough level (P < .0001); and sepsis/systemic inflammatory response syndrome (<.0001), pneumonia (P = .001) or gastrointestinal/genitourinary (P = .025) as the source of infection.

Conclusion:

The incidence of vancomycin-related AKI was higher in blacks, independent of other risk factors. Based on our study, vancomycin trough levels and renal function need to be closely monitored in blacks.

Keywords

race renal vancomycin

Get full access to this article

View all access options for this article.

References

Rybak

Lomaestro

Rotschafer

, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the Infectious Diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009;49(3):325–327.

Liu

Bayer

Cosgrove

, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–e55.

Lodise

Patel

Lomaestro

, et al. Relationship between initial vancomycin concentration-time profile and nephrotoxicity among hospitalized patients. Clin Infect Dis. 2009;49(4):507–514.

United States Renal Data System. 2016 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2016.

Grams

Matsushita

Sang

, et al. Explaining the racial differences in AKI. J Am Soc Nephrol. 2014;25(8):1834–1841.

Quan

Couris

, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173(6):676–682.

Palevsky

Liu

Brophy

, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013;61(5):649–672.

Inker

Astor

Fox

, et al. KDOQI US come entry on the 2012 KDIGO clinical practice guidelines for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–735.

Van Hal

Paterson

Lodise

. Systematic review and meta-analysis of vancomycin-induced nephrotoxicity associated with dosing schedules that maintain troughs between 15 and 20 milligrams per liter. Antimicrob Agents Chemother. 2013;57(2):734–744.

10.

Kullar

Davis

Levine

, et al. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: support for consensus guidelines suggested targets. Clin Infect Dis. 2011;52(8):975–981.

11.

Patel

Pai

Rodvold

, et al. Vancomycin: we can’t get there from here. Clin Infect Dis. 2011;52(8):969–974.

12.

Pritchard

Baker

Leggett

, et al. Increasing vancomycin serum trough concentration and incidence of nephrotoxicity. Am J Med. 2010;123(12):1143–1149.

13.

Lodise

Lomaestro

Graves

, et al. Larger vancomycin doses (at least four grams per day) are associated with an increased incidence of nephrotoxicity. Antimicrob Agents Chemother. 2008;52(4):1330–1336.

14.

Downs

Neihart

Dolezal

, et al. Mild nephrotoxicity associated with vancomycin use. Arch Intern Med. 1989;149(8):1777–1781.

15.

Sorrell

Collignon

. A prospective study of adverse reactions associated with vancomycin therapy. J Antimicrob Chemother. 1985;16(2):235–241.

16.

Hazlewood

Brouse

Pitcher

, et al.

Vancomycin-associated nephrotoxicity: grave concern or death by character assassination?

Am J Med. 2010;123(2):182.e1–182.e7.

17.

Rybak

Albrecht

Boike

, et al. Nephrotoxicity of vancomycin, alone and with an aminoglycoside. J Antimicrob Chemother. 1990;25(4):679–687.

18.

Rutter

Burgess

Talbert

, et al. Acute kidney injury in patients treated with vancomycin and piperacillin-tazobactam: a retrospective cohort analysis. J Hosp Med. 2017;12(2):77–82.

19.

Burgess

Drew

. Comparison of the incidence of vancomycin-induced nephrotoxicity in hospitalized patients with and without concomitant piperacillin-tazobactam. Pharmacotherapy. 2014;34(7):670–676.

20.

Bosso

Nappi

Rudisill

, et al. Relationship between vancomycin trough concentrations and nephrotoxicity: a prospective multicenter trial. J Antimicrob Chemother. 2011;55(12):5475–5479.

21.

Kanji

Powe

Wenger

, et al. Genetic variation in APOL1 associates with younger age at hemodialysis initiation. J Am Soc Nephrol. 2011;22(11):2091–2097.