Renal Safety of a Short Course of Gentamicin in Elderly Patients (the Regent Study)

C. S. B. Sia, M. R. Ananda-Rajah, N. R. Adler, Y.-W. Baey, D. Liew, E. Y. Tong, A. R. Kar Aung

Research output: Contribution to journalMeeting Abstract

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.
Original languageEnglish
Pages (from-to)36
Number of pages1
JournalNephrology
Volume22
Issue numberS3
DOIs
Publication statusPublished - Sept 2017
EventAnnual Scientific Meeting of the Australian-and-New-Zealand-Society-of-Nephrology 2017 - Darwin Convention Centre, Darwin, Australia
Duration: 4 Sept 20176 Sept 2017
Conference number: 53rd
https://onlinelibrary.wiley.com/toc/14401797/2017/22/S3 (Nephrology Vol 22, Issue S3)

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