1962. Vancomycin-Related Renal Insufficiency: Does Race Play a Role?
Session: Poster Abstract Session: Antimicrobial Pharmacokinetics and Pharmacodynamics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Sharma IDSA final.pdf (844.2 kB)
  • Background: African Americans (AA) have a two to four times higher lifetime risk of acute kidney injury (AKI) and chronic kidney disease than Whites. Vancomycin has a potential for nephrotoxicity. The objective of this study is to determine if the incidence of renal insufficiency among patients being treated with vancomycin differs by race.

    Methods: We conducted a retrospective study of adult (³ 18 y) inpatients who were on vancomycin for ³ 48 hours between January 2013 and December 2014. Data on demographics (age, gender, and race), co-morbid conditions, clinical characteristics, vancomycin dose, duration, and nephrotoxic drugs were collected. Patients with a CrCl <30ml/min or undergoing dialysis were excluded. Acute kidney injury (AKI) was defined as an increase in serum creatinine by 0.3 mg/dL or ≥1.5 times the baseline value.  Optimal vancomycin trough levels were defined (10- 20 mg/L) per established guidelines.

    Results: Five hundred and one patients were identified during the study period, 45.5% (228) were AA. Whites were older (p< 0.0001), more likely to be on nephrotoxic drugs (p=0.025) and had a higher prevalence of malignancy (p=0.014); whereas, AA had a higher baseline creatinine (p=0.003) and were more likely to have a history of renal disease (p=0.027), diabetes (p=0.002), and HIV (p=0.004). AKI was seen in 7.2 % (36) of patients; 9.2% (21) AA and 5.5% (15) Whites (p=0.109). Higher vancomycin trough levels (p <0.0001) were associated with AKI. When stratified by race, the odds of developing AKI were higher in Blacks (OR=7.26) compared to Whites (OR=4.97) (Mantel-Haenszel extended χ2  p<0.0001). Multivariate analysis for predicting AKI is shown in the table.

    Conclusion: On univariate analysis, the incidence of AKI was higher in AA than Whites, but the difference did not reach statistical significance. When adjusted for vancomycin trough levels and other factors, however, the data indicated a higher risk of AKI for AA than Whites (p=0.06). Based on our study, different racial nomograms for vancomycin trough levels need to be considered.

    Predictor

    Odds Ratio

    p-value

    95% Confidence Interval

    African American

    2.051

    0.06

     0.97,4.34

    Age

    0.988

    0.36

    0.96,1.01

    Nephrotoxic drugs

     0.718

    0.39

    0.34,1.53

    Diabetes Mellitus

    1.001

    1.0

    0.44,2.28

    Malignancy

    1.801

    0.19

    0.68,4.76

    AIDS

    0.587

    0.66

    0.06,6.16

    Baseline Serum creatinine

    0.193

    0.02

    0.05,.0.78

    High serum vancomycin trough levels

    7.210

    <0.0001

    3.348,15.548

     

     


    Mamta Sharma, MD, FIDSA1,2, Kaylin Braekevelt, BS2, Pramodini Kale-Pradhan, PharmD3,4, Susan Szpunar, PhD1, Malak Abbas, BS5 and Riad Khatib, MD6, (1)St John Hospital and Medical Center, Grosse Pointe Woods, MI, (2)Wayne State University, Detroit, MI, (3)Wayne Sate University, DETROIT, MI, (4)St. John Hospital and Medical Center, Detroit, MI, (5)Wayne State University, DETROIT, MI, (6)Medicine, St. John Hospital & Medical Center, Grosse Pointe Woods, MI

    Disclosures:

    M. Sharma, None

    K. Braekevelt, None

    P. Kale-Pradhan, None

    S. Szpunar, None

    M. Abbas, None

    R. Khatib, None

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