To explore the factors influencing the severity and prognosis of vancomycin-associated acute kidney injury (AKI).

Case reports on vancomycin-associated AKI were collected by searching the relevant databases home and abroad up to June 2020. Patients′ relevant information such as general condition, underlying diseases, infecting species, treatment of vancomycin, baseline serum creatinine (Scr), baseline estimated glomerular filtration rate (eGFR), time from medication to onset of AKI, Scr elevation rate, eGFR decline rate, management of AKI, and outcomes were recorded and descriptively analyzed. The influence factors of the rates of Scr elevation and eGFR decline in patients were analyzed using robust regression method and the influence factors of the prognosis of vancomycin-associated AKI were analyzed by comparing the main clinical features of patients with basic recovery and improvement of Scr level.

A total of 81 reports involving 109 patients were enrolled in the analysis, including 65 males and 44 females, aged from 1 to 84 years with a median age of 49 years, of which 20 were ≤15 years old and 61 (56.0%) suffered from underlying chronic diseases. The median daily dose of vancomycin was 2.00 (0.75, 6.00) g in 89 adult patients and 40.0 (10.3, 240.0) mg/kg in 20 pediatric patients. The median time from medication to onset of AKI was 7 (1, 135) days, and 80 (73.4%) occurred within 14 days after first medication. Seventy-five patients (68.8%) had concomitant use of drugs with potential nephrotoxicity. The median value of peak Scr was 408 (53, 1 000) μmol/L, and the median eGFR was 44.3 (4.2, 280.7) ml/(min·1.73 m ²) after developing AKI. Steady-state trough concentration of vancomycin was recorded in 57 patients, which was 46.2 (11.8,284.0) mg/L before or at onset of AKI. Except 4 patients died and 1 patient was lost to follow-up, the Scr level basically recovered in 50 patients, were improved in 51 patients, and did not recover in 3 patients, which required continuous renal replacement therapy. Robust regression analysis showed that the trough concentration of vancomycin and the number of concomitant nephrotoxic drugs were significantly correlated with the rates of Scr elevation and eGFR decline after AKI (all P<0.05). The age and peak Scr in patients with basic recovery of renal function were significantly lower than those in patients with improved renal function (all P<0.001), while the lowest eGFR value was significantly higher(P=0.036).

Patients with higher trough concentration of vancomycin and more nephrotoxic drugs would have greater elevation of Scr and the decline of eGFR. Older age, higher Scr peak value, and lower eGFR was associated with worse recovery of the renal function.

Vancomycin; Acute kidney injury; Kidney function tests; Glomerular filtration rate; Drug monitoring