Lodise et al identified factors associated with nephrotoxicity in a hospitalized patient who is being treated with vancomycin. The authors are from Albany College, Ordway Research Institute and the University of Illinois at Chicago.


Criteria for nephrotoxicity:

(1) increase in serum creatinine after initiation of vancomycin therapy

(2) (increase by >= 0.5 mg/dL) OR (increase by >= 50%), whichever is greater


Risk factors:

(1) vancomycin trough level in mg/L (ng/mL), with risk increased if the trough is >= 15 mg/L

(2) admission to the ICU


The percentage of patients developing nephrotoxicity are shown in Figure 3. The lines can be approximated by the following:


percentage of patients not in the ICU who develop nephrotoxicity =

= (0.04848 * ((trough level)^2)) - (0.2029 * (trough level)) + 2.331


percentage of patients in the ICU who develop nephrotoxicity =

= (0.04386 * ((trough level)^2)) + (0.8193 * (trough level)) + 5.343


An additional risk factor influencing the time to renal injury was body weight, with shorter time interval if the body weight was >= 101 kg.



• It wouild be interesting to see if body weight persists as a risk factor if lean body weight was used for dosing rather than actual body weight.


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