Association Between Vancomycin Area Under the Curve and Nephrotoxicity: a single center, retrospective cohort study in a veteran population.
Background
It is unclear which vancomycin area under the curve (AUC) values are most associated with risk for acute kidney injury (AKI).


Methods
This retrospective cohort study was undertaken to determine if vancomycin AUC >550 is associated with a higher rate of AKI than an AUC <550. Patients treated with vancomycin for at least 4 days at the VA St. Louis Health Care System from 1/1/2016 to 9/31/2018 were included. The primary outcome was AKI (defined as an increase in serum creatinine by 0.3 mg/dL or 50% from baseline). Secondary outcomes included length of stay, readmission in 30 days, and mortality in 30 days. A bivariate analysis was used to determine other potential factors affecting AKI rate, with significant variables (P < .2) to be included in the multivariate logistic regression analysis to determine independent risk for AKI.


Results
Two hundred patients were included in the analysis; 100 patients with an AUC ≥550 and 100 with an AUC <550. Only mean vancomycin dose (1722.50 mg vs 2361.25 mg; P < .05), mean AUC (465.88 vs 696.45; P < .05), and peak SCr (1.22 mg/dL vs 1.48 mg/dL; P = .015) were significantly different between groups (AUC <550 vs AUC ≥550, respectively). AKI occurred in 42% (42/100) of patients with AUC ≥550 compared with 2% (2/100) of patients with AUC <550 (P < .05). Secondary outcomes were not different between the groups. In the bivariate analysis, age ≥70, CrCl <50 mL/min, and AUC ≥550 (odds ratio, 49.5; 95% CI, 10.1-242.3; P < .05) were found to be independently associated with risk for developing AKI.


Conclusions
Patients with a vancomycin AUC ≥550 were found to have a significantly higher rate of AKI compared with those with an AUC <550.
['Poston-Blahnik|Anna|A|', 'Moenster|Ryan|R|']
vancomycin area under the curve nephrotoxicity pharmacokinetics