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KMID : 0869620150320010040
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Journal of Korean Society of Hospital Pharmacists
2015 Volume.32 No. 1 p.40 ~ p.49
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Risk Factors for Vancomycin-induced Nephrotoxicity
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Lim Ha-Ri
Park So-Jin
Park Hyo-Jung
In Yong-Won
Lee Young-Mee
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Abstract
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Vancomycin-associated nephrotoxicity(VAN) is a well-known adverse effect of vancomycin.The risk further increases in patients who are on concomitant nephrotoxic agents and/or with higher vancomycin dose, longer duration of use, undergoing prolonged duration of therapy, etc. Although the 2009 consensus statements from American Society of Health-System Pharmacists recommended the target trough concentration of above 10 mg/L, the higher trough concentrations have been associated with increased VAN. The purpose of this study is to determine the incidence and risk factors for VAN. In retrospective analysis of adult patients who received vancomycin at Samsung Medical Center, we collected data on patient characteristics as follows; treatment, including daily doses; duration of vancomycin therapy and concomitant nephrotoxic agents; and serum creatinine and vancomycin trough levels. We excluded the patients with the baseline serum creatinine of >2 mg/dL or those with a known history of end-stage renal disease or dialysis at baseline. Clinical characteristics were compared between the patients with and without nephrotoxicity to identify the risk factors associated with VAN. The relationship was observed between the risk factors and the occurrence of nephrotoxicity by using multivariate logistic regression analysis. Of 191 vancomycin-treated patients, nephrotoxicity occurred in 17.8%. In multivariate analysis, higher vancomycin trough concentrations and the use of concomitant nephrotoxic agents were independently associated with nephrotoxicity. Vancomycin trough concentrations of >20 mg/L appeared to be associated with a 6 to 8-fold increased risk of nephrotoxicity, compared to the trough concentrations of <15 mg/L. Our findings suggest the need for additional studies to assess the relationship between the higher vancomycin target trough concentrations and VAN.
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KEYWORD
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Vancomycin, VAN(Vancomycin-associated nephrotoxicity), Nephrotoxicity, Trough
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