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4CPS-119 A real-life study of pharmacokinetic monitoring: nephrotoxic impact of aminoglycosides and vancomycin
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  1. P Blanco Garcia1,
  2. M Anton Martinez1,
  3. S Maganto Garrido1,
  4. M Montero Lázaro1,
  5. A Pariente Junquera1,
  6. A Fijó Prieto1,
  7. C Guitián Bermejo1,
  8. C Mesa Arevalo2,
  9. MT Sánchez Sánchez1
  1. 1Hospital Clínico Universitario De Valladolid, Hospital Pharmacy, Valladolid, Spain
  2. 2Hospital Universitario Río Hortega, Hospital Pharmacy, Valladolid, Spain

Abstract

Background and Importance Therapeutic drug monitoring (TDM) is essential to achieve the pharmacokinetic/pharmacodynamic target avoiding toxicities.

Aim and Objectives To evaluate the impact of renal damage of aminoglycosides and vancomycin in patients making a proactive TDM in a tertiary-hospital.

Material and Methods Retrospective observational analysis from January to December 2022.

Nephrotoxicity variables: shift of final-serum creatinine and initial-serum creatinine (fCr-iCr) and variation of glomerular filtration rate (GFR), estimated according to the CKD-EPI (2009) formula at the end of TDM respect to the baseline. Impact kidney damage: increase of serum creatinine above 0.5 mg/dl or ≥50% the initial value. Pharmacokinetic Bayesian estimation was performed with PKS-Abbott®.

Variables collected demographic (age, sex), clinical (GFR, fCR-iCr, plasma drug level) and hospitalisation unit.

Results We included 123 patients in the study (81 men, mean age 66.6 ± 16.6 years) receiving vancomycin (57/123) and aminoglycosides (66/123). The pharmacist assessed 367 TDM and 255 dosage recommendation.

All patients presented a mean iCr of 1,02 g/dl (±0,69) and fCr of 1,02 g/dl (±0,72): no renal worsening was observed. 7 patients(12.3%) aggravated their GFR with vancomycin, and 10(15,2%) with aminoglycosides.

At the beginning of TDM: 53/123 patients(43,1%) presented a GFR>90ml/min, finding that, at the end of treatment, 48 of them maintained the same GFR and 5 deteriorated it. 34/123 patients(27,6%) showed a moderate GFR(60–89ml/min) before extracting drug levels; only 4 patients(11,8%) exceeded the established damage limit. 36/123 patients(29,3%) presented worst GFR(29–45ml/min), registering 7 patients(19.4%) with associated nephrotoxicity to these drugs.

Looking at the critical-care units: 64/123 patients presented an iCr of 0.93 g/dl (±0.67) and fCr of 0.98g/dl (±0.81). We saw 9(14.1%) patients with renal deterioring despite TDM.

Conclusion and Relevance Patients with a slightly decreased GFR at the baseline showed a higher risk of nephrotoxicity associated to the use of these nephrotoxic drugs. Kidney damage is more evident in critically-care patients. Our sample registered a nephrotoxicity results lower than those published in the studies by Mañez Sevilla M et al.(2015) and the meta-analysis by S J van Hal et al.(2013). Just 17 patients(13.8%) worsened their kidney function after its use.

Strategies such as TDM are necessary to optimise doses and avoid harm. Even so, it is necessary to continue collecting data to expand other possible causes.

Conflict of Interest No conflict of interest.

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