Vancomycin associated acute kidney injury in patients with infectious endocarditis: a large retrospective cohort study

Pan Kunming; Huang Ying; Xu Chenqi; Chen Zhangzhang; Ding Xiaoqiang; Li Xiaoyu; Xu Xialian; Lv Qianzhou

doi:10.3389/fphar.2023.1260802

Vancomycin associated acute kidney injury in patients with infectious endocarditis: a large retrospective cohort study

Front Pharmacol. 2023 Nov 13:14:1260802. doi: 10.3389/fphar.2023.1260802. eCollection 2023.

Authors

Pan Kunming^#¹, Huang Ying^#^{2

3

4}, Xu Chenqi^{2

3}, Chen Zhangzhang¹, Ding Xiaoqiang^{2

3}, Li Xiaoyu¹, Xu Xialian^{2

3}, Lv Qianzhou¹

Affiliations

¹ Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Institute of Kidney Disease and Dialysis, Shanghai, China.
⁴ Department of Nephrology, Zhongshan Hospital, Fudan University, Xiamen, China.

^# Contributed equally.

Abstract

Background: Vancomycin remains the cornerstone antibiotic for the treatment of infective endocarditis (IE). Vancomycin has been associated with significant nephrotoxicity. However, vancomycin associated acute kidney injury (AKI) has not been evaluated in patients with IE. We conducted this large retrospective cohort study to reveal the incidence, risk factors, and prognosis of vancomycin-associated acute kidney injury (VA-AKI) in patients with IE. Methods: Adult patients diagnosed with IE and receiving vancomycin were included. The primary outcome was VA-AKI. Results: In total, 435 of the 600 patients were enrolled. Of these, 73.6% were male, and the median age was 52 years. The incidence of VA-AKI was 17.01% (74). Only 37.2% (162) of the patients received therapeutic monitoring of vancomycin, and 30 (18.5%) patients had reached the target vancomycin trough concentration. Multiple logistic regression analysis revealed that body mass index [odds ratio (OR) 1.088, 95% CI 1.004, 1.179], duration of vancomycin therapy (OR 1.030, 95% CI 1.003, 1.058), preexisting chronic kidney disease (OR 2.291, 95% CI 1.018, 5.516), admission to the intensive care unit (OR 2.291, 95% CI 1.289, 3.963) and concomitant radiocontrast agents (OR 2.085, 95% CI 1.093, 3.978) were independent risk factors for VA-AKI. Vancomycin variety (Lai Kexin vs. Wen Kexin, OR 0.498, 95% CI 0.281, 0.885) were determined to be an independent protective factor for VI-AKI. Receiver operator characteristic curve analysis revealed that duration of therapy longer than 10.75 days was associated with a significantly increased risk of VA-AKI (HR 1.927). Kidney function was fully or partially recovered in 73.0% (54) of patients with VA-AKI. Conclusion: The incidence of VA-AKI in patients with IE was slightly higher than in general adult patients. Concomitant contrast agents were the most alarmingly nephrotoxic in patients with IE, adding a 2-fold risk of VA-AKI. In patients with IE, a course of vancomycin therapy longer than 10.75 days was associated with a significantly increased risk of AKI. Thus, closer monitoring of kidney function and vancomycin trough concentrations was recommended in patients with concurrent contrast or courses of vancomycin longer than 10.75 days.

Keywords: acute kidney injury; duration of therapy; infectious endocarditis; risk factors; vancomycin.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (NO.82204520), the Chinese Pharmaceutical Association (No.CPA-Z05-ZC-2021-002), China International Medical Foundation (No.Z-2021-46-2101), Shanghai Pharmaceutical Association [No. (2023)04], the Shanghai Municipal Health Commission (No.202240293) and Shanghai Municipal Health Commission (No. shslczdzk06504).