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Baseline kidney function is associated with vancomycin-induced acute kidney injury in children: a prospective nested case-control study

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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.

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Funding

This work was funded by The Key Project of Science and Technology of Wuhan (2013060602010258) and National Futang Fund for Children’s Medicine Development (2015 No.33).

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Authors and Affiliations

  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

    Huanian Zhang, Ping Gao, Yang Wang & Shiying Yuan

  2. Department of Clinical Pharmacol, Shandong Liaocheng Children’s Hospital, Shandong Liaocheng, 252002, China

    Jianzhong Chen & Guangwei Jia

  3. Department of ICU, Wuhan Children’s Hospital, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, 430016, China

    Furong Zhang

  4. Department of Pediatric Hematology, Wuhan Children’s Hospital, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, 430016, China

    Fang Tao

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  1. Huanian Zhang
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  2. Ping Gao
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  3. Yang Wang
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  4. Jianzhong Chen
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  7. Fang Tao
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Contributions

HZ designed and organized the study; PG conducted the study and wrote the manuscript; YW analyzed the data; JC and GJ conducted the study; FZ, TF, and SY contributed to the interpretation of the data.

Corresponding author

Correspondence to Huanian Zhang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the ethics committee of Wuhan Children’s Hospital of Tongji Medical College of Huazhong University of Science and Technology (No. 2016070).

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Informed consent was obtained from all individual participants and their legal guardians.

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Zhang, H., Gao, P., Wang, Y. et al. Baseline kidney function is associated with vancomycin-induced acute kidney injury in children: a prospective nested case-control study. Pediatr Nephrol 36, 1299–1306 (2021). https://doi.org/10.1007/s00467-020-04820-z

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  • DOI: https://doi.org/10.1007/s00467-020-04820-z

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