Estimation of the initial dose setting of vancomycin therapy with use of cystatin C as a new marker of renal function.
In recent years, it has been suggested that the glomerular filtration rate (GFR) can be predicted on the basis of serum cystatin C concentrations and that this measurement is more sensitive than serum creatinine concentration as a marker of renal function. In this study, to investigate the clinical utility of the initial dose setting of vancomycin by the population mean method with use of serum cystatin C as a marker of renal function, we compared the correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine concentrations in elderly (>/=65 years old) and nonelderly (<65 years old) patients. An analysis of prediction accuracy (bias) and precision was evaluated by calculating the mean prediction error (ME), the mean absolute error (MAE), and the root mean squared prediction error (RMSE). For nonelderly patients (n = 50), there was no significant difference in the MAE based on the use of serum creatinine or serum cystatin C concentration. However, for elderly patients (n = 105), the MAE based on serum cystatin C concentration was significantly better than that based on serum creatinine level. These results suggest that serum cystatin C is a good marker of renal function in comparison with serum creatinine for dose setting of vancomycin, especially in an elderly population.
Tanaka
Akihiro
A
Division of Pharmacy, Ehime University Hospital, Ehime, Japan.
Suemaru
Katsuya
K
Otsuka
Takashi
T
Ido
Keiko
K
Nishimiya
Tatsuya
T
Sakai
Ikuya
I
Hasegawa
Hitoshi
H
Inoue
Tomoyoshi
T
Murase
Mitsuharu
M
Yasukawa
Masaki
M
Araki
Hiroaki
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000378:metabolism; D014640:Vancomycin / Q000008:administration & dosage* / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D014640:Vancomycin