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Yoshida Y, Fukuda T, Fukuoka K, Nagayama T, Tanihara T, Nishikawa N, Otsuki K, Terada Y, Hamamura K, Oyama K, Tsuruta A, Mayanagi K, Koyanagi S, Matsunaga N, Ohdo S. Time-Dependent Differences in Vancomycin Sensitivity of Macrophages Underlie Vancomycin-Induced Acute Kidney Injury. J Pharmacol Exp Ther 2024; 388:218-227. [PMID: 38050132 DOI: 10.1124/jpet.123.001864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/21/2023] [Accepted: 11/07/2023] [Indexed: 12/06/2023] Open
Abstract
Although vancomycin (VCM)-frequently used to treat drug-resistant bacterial infections-often induces acute kidney injury (AKI), discontinuation of the drug is the only effective treatment; therefore, analysis of effective avoidance methods is urgently needed. Here, we report the differences in the induction of AKI by VCM in 1/2-nephrectomized mice depending on the time of administration. Despite the lack of difference in the accumulation of VCM in the kidney between the light (ZT2) and dark (ZT14) phases, the expression of AKI markers due to VCM was observed only in the ZT2 treatment. Genomic analysis of the kidney suggested that the time of administration was involved in VCM-induced changes in monocyte and macrophage activity, and VCM had time-dependent effects on renal macrophage abundance, ATP activity, and interleukin (IL)-1β expression. Furthermore, the depletion of macrophages with clodronate abolished the induction of IL-1β and AKI marker expression by VCM administration at ZT2. This study provides evidence of the need for time-dependent pharmacodynamic considerations in the prevention of VCM-induced AKI as well as the potential for macrophage-targeted AKI therapy. SIGNIFICANCE STATEMENT: There is a time of administration at which vancomycin (VCM)-induced renal injury is more and less likely to occur, and macrophages are involved in this difference. Therefore, there is a need for time-dependent pharmacodynamic considerations in the prevention of VCM-induced acute kidney injury as well as the potential for macrophage-targeted acute kidney injury therapy.
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Affiliation(s)
- Yuya Yoshida
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Fukuda
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohei Fukuoka
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshitaka Nagayama
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohito Tanihara
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Nishikawa
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kaita Otsuki
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuma Terada
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kengo Hamamura
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Oyama
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Akito Tsuruta
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Kota Mayanagi
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoru Koyanagi
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoya Matsunaga
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigehiro Ohdo
- Departments of Clinical Pharmacokinetics (Y.Y., T.F., T.N., T.T., N.N., K.O., Y.T., K.H., N.M.), Pharmaceutics (K.F., K.O., S.O.), Glocal Healthcare Science (A.T., S.K.), and Drug Discovery Structural Biology (K.M.), Faculty of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan
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Kunming P, Ying H, Chenqi X, Zhangzhang C, Xiaoqiang D, Xiaoyu L, Xialian X, Qianzhou L. Vancomycin associated acute kidney injury in patients with infectious endocarditis: a large retrospective cohort study. Front Pharmacol 2023; 14:1260802. [PMID: 38026976 PMCID: PMC10679345 DOI: 10.3389/fphar.2023.1260802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Vancomycin remains the cornerstone antibiotic for the treatment of infective endocarditis (IE). Vancomycin has been associated with significant nephrotoxicity. However, vancomycin associated acute kidney injury (AKI) has not been evaluated in patients with IE. We conducted this large retrospective cohort study to reveal the incidence, risk factors, and prognosis of vancomycin-associated acute kidney injury (VA-AKI) in patients with IE. Methods: Adult patients diagnosed with IE and receiving vancomycin were included. The primary outcome was VA-AKI. Results: In total, 435 of the 600 patients were enrolled. Of these, 73.6% were male, and the median age was 52 years. The incidence of VA-AKI was 17.01% (74). Only 37.2% (162) of the patients received therapeutic monitoring of vancomycin, and 30 (18.5%) patients had reached the target vancomycin trough concentration. Multiple logistic regression analysis revealed that body mass index [odds ratio (OR) 1.088, 95% CI 1.004, 1.179], duration of vancomycin therapy (OR 1.030, 95% CI 1.003, 1.058), preexisting chronic kidney disease (OR 2.291, 95% CI 1.018, 5.516), admission to the intensive care unit (OR 2.291, 95% CI 1.289, 3.963) and concomitant radiocontrast agents (OR 2.085, 95% CI 1.093, 3.978) were independent risk factors for VA-AKI. Vancomycin variety (Lai Kexin vs. Wen Kexin, OR 0.498, 95% CI 0.281, 0.885) were determined to be an independent protective factor for VI-AKI. Receiver operator characteristic curve analysis revealed that duration of therapy longer than 10.75 days was associated with a significantly increased risk of VA-AKI (HR 1.927). Kidney function was fully or partially recovered in 73.0% (54) of patients with VA-AKI. Conclusion: The incidence of VA-AKI in patients with IE was slightly higher than in general adult patients. Concomitant contrast agents were the most alarmingly nephrotoxic in patients with IE, adding a 2-fold risk of VA-AKI. In patients with IE, a course of vancomycin therapy longer than 10.75 days was associated with a significantly increased risk of AKI. Thus, closer monitoring of kidney function and vancomycin trough concentrations was recommended in patients with concurrent contrast or courses of vancomycin longer than 10.75 days.
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Affiliation(s)
- Pan Kunming
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huang Ying
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Institute of Kidney Disease and Dialysis, Shanghai, China
- Department of Nephrology, Zhongshan Hospital, Fudan University, Xiamen, China
| | - Xu Chenqi
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Institute of Kidney Disease and Dialysis, Shanghai, China
| | - Chen Zhangzhang
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ding Xiaoqiang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Institute of Kidney Disease and Dialysis, Shanghai, China
| | - Li Xiaoyu
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xu Xialian
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease, Institute of Kidney Disease and Dialysis, Shanghai, China
| | - Lv Qianzhou
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
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Cherian JP, Jones GF, Bachina P, Helsel T, Virk Z, Lee JH, Fiawoo S, Salinas A, Dzintars K, O'Shaughnessy E, Gopinath R, Tamma PD, Cosgrove SE, Klein EY. An Electronic Algorithm to Identify Vancomycin-Associated Acute Kidney Injury. Open Forum Infect Dis 2023; 10:ofad264. [PMID: 37383251 PMCID: PMC10296058 DOI: 10.1093/ofid/ofad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 06/30/2023] Open
Abstract
Background The burden of vancomycin-associated acute kidney injury (V-AKI) is unclear because it is not systematically monitored. The objective of this study was to develop and validate an electronic algorithm to identify cases of V-AKI and to determine its incidence. Methods Adults and children admitted to 1 of 5 health system hospitals from January 2018 to December 2019 who received at least 1 dose of intravenous (IV) vancomycin were included. A subset of charts was reviewed using a V-AKI assessment framework to classify cases as unlikely, possible, or probable events. Based on review, an electronic algorithm was developed and then validated using another subset of charts. Percentage agreement and kappa coefficients were calculated. Sensitivity and specificity were determined at various cutoffs, using chart review as the reference standard. For courses ≥48 hours, the incidence of possible or probable V-AKI events was assessed. Results The algorithm was developed using 494 cases and validated using 200 cases. The percentage agreement between the electronic algorithm and chart review was 92.5% and the weighted kappa was 0.95. The electronic algorithm was 89.7% sensitive and 98.2% specific in detecting possible or probable V-AKI events. For the 11 073 courses of ≥48 hours of vancomycin among 8963 patients, the incidence of possible or probable V-AKI events was 14.0%; the V-AKI incidence rate was 22.8 per 1000 days of IV vancomycin therapy. Conclusions An electronic algorithm demonstrated substantial agreement with chart review and had excellent sensitivity and specificity in detecting possible or probable V-AKI events. The electronic algorithm may be useful for informing future interventions to reduce V-AKI.
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Affiliation(s)
- Jerald P Cherian
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - George F Jones
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Preetham Bachina
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Taylor Helsel
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zunaira Virk
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jae Hyoung Lee
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Suiyini Fiawoo
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alejandra Salinas
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kate Dzintars
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth O'Shaughnessy
- Division of Anti-Infectives, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Ramya Gopinath
- Division of Anti-Infectives, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Pranita D Tamma
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Kunming P, Xiaotian J, Qing X, Chenqi X, Xiaoqiang D, Qian Zhou L. Impact of pharmacist intervention in reducing vancomycin-associated acute kidney injury: A systematic review and meta-analysis. Br J Clin Pharmacol 2023; 89:526-535. [PMID: 35285970 DOI: 10.1111/bcp.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS The aim was to quantify the relationship between pharmacist intervention and vancomycin-associated acute kidney injury (AKI). METHODS Electronic databases were searched up to August 2020 for meta-analyses of cohort studies and/or randomized controlled trials. Studies that compared the incidence of AKI in patients between post- and prepharmacist intervention were investigated. The primary outcome was incidence of AKI. We also evaluated the influence of pharmacist intervention in risk factors of vancomycin-associated AKI. RESULTS The search strategy retrieved 1744 studies and 34 studies with 19 298 participants were included (22 published articles and 12 abstracts from conference proceedings). Compared with the preintervention group, the postintervention group patients had a significantly lower incidence of vancomycin-associated AKI: 7.3% for post- and 9.6% for preintervention (odds ratio [OR] 0.52, 95% confidence interval [CI]; 0.41, 0.67], P < .00001). The rate of attaining target concentration was significantly higher in the post- than preintervention group (OR 2.86, 95% CI [2.23, 3.67], P < .00001). The postintervention group significantly improved the percentage of serum creatinine laboratory tests than preintervention group (OR = 3.24, 95% CI 2.02, 5.19], P < .00001). Patients postintervention had markedly lower risk of mortality than preintervention patients (OR 0.47, 95% CI [0.31, 0.72], P = .0004). CONCLUSION Pharmacist intervention in vancomycin treatment significantly decreased the rate of vancomycin-associated AKI, while improving efficacy and reducing mortality. We speculate that this is because the pharmacist interventions optimized the rationality of vancomycin therapy, monitoring of vancomycin trough concentration and the monitoring of patients' renal function.
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Affiliation(s)
- Pan Kunming
- Department of Pharmacy, ZhongShan Hospital FuDan University, ShangHai, China
| | - Jiang Xiaotian
- Department of Nephrology, ZhongShan Hospital FuDan University, ShangHai, China
| | - Xu Qing
- Department of Pharmacy, ZhongShan Hospital FuDan University, ShangHai, China
| | - Xu Chenqi
- Department of Nephrology, ZhongShan Hospital FuDan University, ShangHai, China
| | - Ding Xiaoqiang
- Department of Nephrology, ZhongShan Hospital FuDan University, ShangHai, China
| | - Lv Qian Zhou
- Department of Pharmacy, ZhongShan Hospital FuDan University, ShangHai, China
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