• Elizabeth A Sinclair, Gayane Yenokyan, Andrea McMunn, Jeffrey J Fadrowski, Aaron M Milstone, and Carlton K K Lee.
• Texas Children's Hospital, Houston, TX, USA easincla@texaschildrens.org.
• Ann Pharmacother. 2014 Dec 1; 48 (12): 1555-62.

BackgroundAs 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.ObjectiveTo determine the incidence of AKI in children receiving intravenous vancomycin and to identify factors associated with increased odds of AKI.MethodsA 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.ResultsOf 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.ConclusionsAKI 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.© The Author(s) 2014.

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