Factors Associated with Acute Kidney Injury in Elderly Patients Receiving Vancomycin

Abstract

Objective: To determine factors associated with the acute kidney injury (AKI) in elderly patients treated with vancomycin. Methods: The subjects in this cross-sectional study were patients aged 60 years and over who received intravenous vancomycin. The study collected data from inpatient medical records of King Memorial Chulalongkorn Hospital, Thai Red Cross Society from January 2017 to June 2019. The researchers assessed AKI by using the KDIGO criteria and determined its association with eight factors including body mass index, Charlson comorbidity Index score, average daily dose, duration of vancomycin treated, means plasma vancomycin trough level (C_{ave, trough}), the number of concomitant nephrotoxic drugs, and baseline plasma albumin by using binary logistic regression. Results: The majority of 244 subjects treated with intravenous vancomycin were female (53.69%). The median age was 72.15 (65.23, 80.10) years. Sixty four subjects developed AKI during vancomycin treatment. Factors significantly associated with the AKI in elderly vancomycin-treated patients were C_{ave, trough}, and 2 or more of concomitant nephrotoxic drugs. The patients with C_ave, _trough at 15.0-20.0 mg/L and those with C_ave, _trough greater than 20.0 mg/L were at a higher risk of AKI than those with C_ave, _trough less than 15.0 mg/L with adjusted odd ratio (OR_adj) = 3.98 (95% CI = 1.24-12.75) and OR_adj = 7.40 (95% CI = 2.47-22.16), respectively. The group receiving two or more of concomitant nephrotoxic drugs had a higher risk of AKI than those with less than two nephrotoxic drugs with OR_adj= 3.44 (95 %CI =1.57-7.56). Conclusions: Factors associated with AKI in elderly under vancomycin treatment were mean plasma vancomycin at trough levels and concomitant use of two or more nephrotoxic drugs. The hospital could apply the finding to improve the surveillance of AKI in elderly patient receiving vancomycin.