title: A comparative assessment of vancomycin-associated nephrotoxicity in the young versus the elderly hospitalized patient.
abstract: The incidence of vancomycin-associated nephrotoxicity was determined in a younger (age < 60 y) versus elderly (age > or = 60 y) hospitalized adult population to identify associated drug- and nondrug-related risk factors. Nephrotoxicity was defined as an acute increase in serum creatinine of > or = 44.2 mumol/L if baseline serum creatinine was < or = 221 mumol/L or an increase in serum creatinine of > or = 88.4 mumol/L if baseline serum creatinine > 221 mumol/L. A total of 289 patients, 141 younger (mean age, +/- S.D. 37.9 +/- 12.4 y) and 148 elderly (73.6 +/- 8.5 years), was retrospectively reviewed. Nephrotoxicity occurred in 7.8% younger vs 18.9% elderly patients (P = 0.003). Using multivariate logistic regression models for the pooled patient population, concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (relative risk (R.R.) = 5.06); for the younger population, only concurrent amphotericin B use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 6.65); and for the elderly population, only concurrent loop diuretic use was significantly associated with vancomycin-associated nephrotoxicity (R.R. = 9.70). These data suggest that elderly patients are at significantly greater risk of vancomycin-associated nephrotoxicity than are younger patients. However, because age was not a significant risk factor for nephrotoxicity in comparing the pooled vancomycin-associated nephrotoxicity group compared to the non-nephrotoxicity group, the differences observed between age groups probably reflect differences in risk factor prevalence.
authors.affiliation: College of Pharmacy, University of Minnesota, Minneapolis.
authors.forename: K
authors.initials: K
authors.lastname: Vance-Bryan
authors.forename: J C
authors.initials: JC
authors.lastname: Rotschafer
authors.forename: S S
authors.initials: SS
authors.lastname: Gilliland
authors.forename: K A
authors.initials: KA
authors.lastname: Rodvold
authors.forename: C M
authors.initials: CM
authors.lastname: Fitzgerald
authors.forename: D R
authors.initials: DR
authors.lastname: Guay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology*; D001499:Bayes Theorem; D005260:Female; D016231:Fluorescence Polarization Immunoassay; D006207:Half-Life; D006760:Hospitalization; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects* / Q000493:pharmacokinetics
chemical_list: D014640:Vancomycin