title: Factors associated with acute kidney injury in children receiving vancomycin.
abstract: BACKGROUND
  As higher vancomycin doses have been used in children, concern for acute kidney injury (AKI) has increased. Data describing factors associated with AKI, particularly dose-related factors, are limited.
  
  
  OBJECTIVE
  To determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI.
  
  
  METHODS
  A retrospective review of patients admitted to a tertiary academic pediatric hospital from February 2009 to September 2010 was performed. Patients 3 months to <19 years old with normal kidney function, receiving vancomycin for at least 48 hours were included. Incidence of AKI was assessed as defined by the Pediatric-Modified RIFLE criteria. Patients with and without AKI were compared to determine factors associated with increased odds of AKI, focusing on vancomycin dose.
  
  
  RESULTS
  Of 175 patients included, 24 (13.7%) met AKI criteria. In a multivariate regression, likelihood of AKI increased with each 5 mg/kg increase in vancomycin dose (odds ratio [OR] = 1.16; 95% CI = 1.01-1.33). Odds of AKI increased with each additional day of therapy (OR = 1.11; 95% CI = 1.01-1.22) and use of concomitant nephrotoxic medications (OR = 5.02; 95% CI = 1.09-23.19). The study was limited by small sample size and retrospective design.
  
  
  CONCLUSIONS
  AKI was common in children receiving vancomycin. Higher doses of vancomycin were associated with increased odds of AKI. The risks and benefits of higher vancomycin dosing should be considered for each patient. Patients should be monitored closely for AKI, especially with higher doses, extended durations of therapy, or concomitant use of nephrotoxic medications.
authors.affiliation: Texas Children's Hospital, Houston, TX, USA easincla@texaschildrens.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sinclair
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Gayane
authors.initials: G
authors.lastname: Yenokyan
authors.affiliation: Kaiser Permanente Capitol Hill Medical Center, Washington, DC, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: McMunn
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Fadrowski
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Carlton K K
authors.initials: CK
authors.lastname: Lee
mesh_terms: D000046:Academic Medical Centers; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: acute kidney injury; adverse drug event; nephrotoxicity; pediatrics; vancomycin