1. Candidates for area under the concentration–time curve (AUC)-guided dosing and risk reduction based on analyses of risk factors associated with nephrotoxicity in vancomycin-treated patients
- Author
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Naoto Hashimoto, Toshimi Kimura, Yukihiro Hamada, Takashi Niwa, Yuki Hanai, Masayuki Chuma, Satoshi Fujii, Kazuaki Matsumoto, Akari Shigemi, Hideki Kawamura, Yoshiko Takahashi, and Yoshio Takesue
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Vancomycin ,Nephrotoxicity ,Acute kidney injury ,Area under the concentration–time curve ,AUC ,Therapeutic drug monitoring ,Microbiology ,QR1-502 - Abstract
ABSTRACT: Objectives: : Compared with vancomycin trough concentration (Cmin)-guided dosing, area under the concentration–time curve (AUC)-guided dosing is associated with decreased acute kidney injury (AKI). However, whether Cmin-guided or AUC-guided dosing should be used in patients other than those with serious MRSA infections remains uncertain. The purposes of this multicentre study were to identify risk factors for early- and late-phase vancomycin-induced AKI and to identify candidates for AUC-guided dosing, rather than Cmin-guided dosing, who require a more accurate dose titration to reduce the AKI risk. Methods: : A multivariate logistic regression analysis was applied to identify risk factors for AKI. Additionally, the cut‑off day for AKI onset, cut-off Cmin for AKI, safe Cmin for reduced AKI risk and probability of AKI were calculated. Results: : In total, 8.4% (159/1882) of patients developed AKI. AKI occurred within the first 7 days of therapy (early phase) in the vast majority of patients. Significant risk factors for AKI during the early phase were identified as Cmin > 20 mg/L, ICU stay, concurrent diuretic or piperacillin/tazobactam use, and pre-existing renal dysfunction. A temporarily elevated Cmin (>15–20 mg/L) was not associated with a greater risk of AKI. In patients with risk factors, the cut-off Cmin for AKI and the estimated safe Cmin for reduced AKI risk were 18.8–21.0 mg/L and
- Published
- 2021
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