Abstract
Aim
To determine the incidence of acute kidney injury (AKI) in elderly patients receiving a short course of gentamicin, clinical risk factors and outcomes related to AKI.
Background
A short course of gentamicin is recommended by the Australian Therapeutic Guidelines as empiric treatment for gram negative bacteria, however the incidence of nephrotoxicity in elderly patients has not been studied.
Methods
Retrospective cohort study from April 2013 to 2015 at the Alfred and Sandringham Hospital, Melbourne Australia. Participants included elderly (aged ≥65 years) patients admitted to hospital from the ED who received gentamicin. The primary outcome, AKI was defined as a rise in serum creatinine by ≥50% and/or ≥26.5μmol/L within 14 days of first gentamicin dose.
Results
The incidence of AKI was 14.9% (36/242 patients). A composite serious adverse renal outcome (persistent kidney injury, requirement for renal replacement therapy or inpatient death in a patient with AKI) occurred in 10 (4.1%) patients. Patients who developed AKI were older (median 80.5 vs 78 years, p=0.026), had higher Charlson co-morbidity index (median 7 vs 5, p=0.0004), had more advanced chronic kidney disease (CKD) at baseline (Stage IV and V) (OR 4.38, 95% CI=1.45-13.2, p=0.013) and were more likely to have received diuretics within the first 72 hours (OR 2.35, 95% CI 1.13-4.92, p=0.025). Mortality was increased in those with AKI (13.9% vs. 4.4%, p=0.04). When adjusted for confounders, Stage IV CKD or worse remained associated with AKI.
Conclusions
In a cohort of elderly patients with predominantly Stage II CKD, in whom the majority received a single dose of gentamicin, the incidence of AKI was 14.9%. AKI was transient in the majority of patients.
To determine the incidence of acute kidney injury (AKI) in elderly patients receiving a short course of gentamicin, clinical risk factors and outcomes related to AKI.
Background
A short course of gentamicin is recommended by the Australian Therapeutic Guidelines as empiric treatment for gram negative bacteria, however the incidence of nephrotoxicity in elderly patients has not been studied.
Methods
Retrospective cohort study from April 2013 to 2015 at the Alfred and Sandringham Hospital, Melbourne Australia. Participants included elderly (aged ≥65 years) patients admitted to hospital from the ED who received gentamicin. The primary outcome, AKI was defined as a rise in serum creatinine by ≥50% and/or ≥26.5μmol/L within 14 days of first gentamicin dose.
Results
The incidence of AKI was 14.9% (36/242 patients). A composite serious adverse renal outcome (persistent kidney injury, requirement for renal replacement therapy or inpatient death in a patient with AKI) occurred in 10 (4.1%) patients. Patients who developed AKI were older (median 80.5 vs 78 years, p=0.026), had higher Charlson co-morbidity index (median 7 vs 5, p=0.0004), had more advanced chronic kidney disease (CKD) at baseline (Stage IV and V) (OR 4.38, 95% CI=1.45-13.2, p=0.013) and were more likely to have received diuretics within the first 72 hours (OR 2.35, 95% CI 1.13-4.92, p=0.025). Mortality was increased in those with AKI (13.9% vs. 4.4%, p=0.04). When adjusted for confounders, Stage IV CKD or worse remained associated with AKI.
Conclusions
In a cohort of elderly patients with predominantly Stage II CKD, in whom the majority received a single dose of gentamicin, the incidence of AKI was 14.9%. AKI was transient in the majority of patients.
| Original language | English |
|---|---|
| Pages (from-to) | 36 |
| Number of pages | 1 |
| Journal | Nephrology |
| Volume | 22 |
| Issue number | S3 |
| DOIs | |
| Publication status | Published - Sep 2017 |
| Event | Annual Scientific Meeting of the Australian-and-New-Zealand-Society-of-Nephrology 2017 - Darwin Convention Centre, Darwin, Australia Duration: 4 Sep 2017 → 6 Sep 2017 Conference number: 53rd https://onlinelibrary.wiley.com/toc/14401797/2017/22/S3 (Nephrology Vol 22, Issue S3) |