Baseline kidney function is associated with vancomycin-induced acute kidney injury in children: a prospective nested cas
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ORIGINAL ARTICLE
Baseline kidney function is associated with vancomycin-induced acute kidney injury in children: a prospective nested case-control study Huanian Zhang 1 Shiying Yuan 1
&
Ping Gao 1 & Yang Wang 1 & Jianzhong Chen 2 & Guangwei Jia 2 & Furong Zhang 3 & Fang Tao 4 &
Received: 29 June 2020 / Revised: 30 September 2020 / Accepted: 12 October 2020 # IPNA 2020
Abstract Background Children with kidney insufficiency are susceptible to vancomycin-induced acute kidney injury (VIAKI), but there is a lack of compelling clinical data. We conducted a nested case-control study to evaluate the relationship between kidney insufficiency and incidence of VIAKI in children. Methods Patients were considered to have VIAKI if they met the criteria for eGFR change according to pRIFLE-I or p-RIFLE-F. Case group comprised patients who developed VIAKI. Case-control ratio was 1:3; patients were matched for age, severity, and nature of illness and initial vancomycin dose. Primary endpoint was incidence of VIAKI at three levels of kidney function, calculated using Kaplan-Meier curve and log-rank test. Secondary endpoint was treatment-related in-hospital mortality amongst case and control groups. Results Amongst 386 children who fit study criteria, 31 developed VIAKI (8.03%). Thirty-one cases and 93 controls were selected from the observed cohort. Three risk factors were identified for VIAKI: moderate kidney insufficiency (OR 8.8, 2.4– 32.8), vancomycin trough concentration ≥ 15 μg/mL (OR 7.7, 1.7–34.4), and furosemide use (OR 24.8, 6.4–98.2). A significant difference in time to VIAKI was noted between patients with moderate kidney insufficiency and patients with mild kidney insufficiency or normal kidney function (p < 0.001). In-hospital mortality rate in case group was 45.2%, compared to 18.3% in control group (p < 0.01). Conclusions Children with moderate kidney insufficiency are more likely to develop VIAKI than those with normal and mild kidney insufficiency. Patients who develop VIAKI have higher in-hospital mortality than those who do not develop VIAKI. Supplementary Information The online version of this article (https:// doi.org/10.1007/s00467-020-04820-z) contains supplementary material, which is available to authorized users. * Huanian Zhang [email protected] Ping Gao [email protected]
Shiying Yuan [email protected] 1
Department of Clinical Pharmacol, Wuhan Children’s Hospital, Tongji Medical College,Huazhong University of Science and Technology, 100 Hong Kong road, Jiang’an district, Wuhan 430016, China
Jianzhong Chen [email protected]
2
Department of Clinical Pharmacol, Shandong Liaocheng Children’s Hospital, Shandong Liaocheng 252002, China
Guangwei Jia [email protected]
3
Department of ICU, Wuhan Children’s Hospital, Tongji Medical College,Huazhong University of Science and Technology, Wuhan 430016, China
4
Department of Pediatric Hematology, Wuhan Children’s Hospital, Tongji Medical College,Huazhong University of Science and Technology, Wuhan 430016, China
Yang Wang [email protected]
Furong Zh
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