Acute kidney injury associated with vancomycin: prospective study of the incidence, risk factors and mortality in critical patients

Abstract

Acute Kidney Injury (AKI) is a common and complex syndrome defined as sudden decline of glomerular filtration rate. It reachs up to 40% of patients in intensive care units (ICU) and is associated with high mortality (about 70% of the cases). There are several risk factors for AKI and the most frequent are advanced age, sepsis, shock, heart failure, liver disease, major surgery, and various nephrotoxins such as contrast-medium and some antibiotics. In the critically ill, sepsis is the major cause of AKI, accounting for nearly 50% of cases. In patients suffering from sepsis, vancomycin, a potentially nephrotoxic antibiotic, is frequently used. The occurrence of AKI due to vancomycin use occurs in about 8-45% of cases, being the main risk factors its use for seven days or more, high serum doses, simultaneous use of other nephrotoxic drugs, previous chronic kidney disease, metabolic acidosis and sodium depletion. Although AKI is a disease associated with high mortality rates, there is of studies evaluating the incidence of AKI and the use of vancomycin in ICU patients. The main objectives of this study are to evaluate the incidence of AKI associated with vancomycin use in adult patients admitted to ICU, to identify risk factors for this clinical condition, compare the survival of patients that use vancomycin that developed AKI with those who did not develop, identify risk factors for death of patients with AKI associated with vancomycin and compare the survival of patients with AKI associated with vancomycin and those who developed AKI of other etiologies. This is a prospective and observational cohort study of patients using vancomycin and hospitalized in adults ICUs from Botucatu School of Medicine Hospital for 12 consecutive months. The data will be obtained by a single observer, through consultation with the patient and his medical records, since the admission to ICU until the end of the vancomycin use. It is estimated that at the end of the study about 150 patients were assessed. Different statistical tests will be applied to the analysis of the results, with 5% significance level.