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.