Risk factors for vancomycin-associated acute kidney injury: A systematic review and meta-analysis

Aims: This systematic literature review and meta-analysis aimed to evaluate the risk factors for vancomycin-associated acute kidney injury (AKI) incidence. Methods: This study assessed risk factors for vancomycin-associated AKI in adult patients by searching studies from PubMed, the Cochrane Library and Embase. Random effect models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Fifty-three studies were included in our meta-analysis. For patient factors, black race (OR 1.47, 95% CI: 1.16–1.87), Caucasian (OR 0.72, 95% CI: 0.58–0.90) and obesity (OR 1.46, 95% CI: 1.12–1.90) were associated with an increase in vancomycin-associated AKIs. In terms of vancomycin-related factors, longer treatment duration (>14 d; OR 1.73, 95% CI: 1.06–2.83), serum vancomycin trough level >15 μg/mL (OR 2.10, 95% CI: 1.43–3.07) and vancomycin trough level >20 μg/mL (OR 2.84, 95% CI: 1.48–5.44) increased the risks of vancomycin-associated AKI. For comorbidities and clinical factors, renal disease (OR 2.19, 95% CI: 1.51–3.17) showed the highest odds of vancomycin-associated AKI, followed by hepatic disease, intensive care unit admission, heart failure, sepsis, coronary heart disease and diabetes mellitus. For concomitant nephrotoxic drugs, amphotericin B (OR 5.21, 95% CI: 3.44–7.87) showed the highest odds of vancomycin-associated AKI, followed by acyclovir (OR 3.22, 95% CI: 1.39–7.46), vasopressors, loop diuretics, piperacillin–tazobactam and aminoglycoside. The use of any concomitant nephrotoxic agent (OR 1.74, 95% CI: 1.17–2.58) increased the odds of vancomycin-associated AKI. Conclusion: Our results may help predict the risk of vancomycin-associated AKI in the clinical setting.