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. 2023 Dec;77(6):595-605.
doi: 10.18926/AMO/66151.

Concomitant Use of Multiple Nephrotoxins including Renal Hypoperfusion Medications Causes Vancomycin-Associated Nephrotoxicity: Combined Retrospective Analyses of Two Real-World Databases

Takashi Bando  1   2 , Masayuki Chuma  3   4 , Hirofumi Hamano  2   5 , Takahiro Niimura  3 , Naoto Okada  1 , Masateru Kondo  1 , Yuki Izumi  1 , Shunsuke Ishida  1 , Toshihiko Yoshioka  1 , Mizuho Asada  6 , Yoshito Zamami  2   5 , Kenshi Takechi  7 , Mitsuhiro Goda  1   2 , Koji Miyata  2 , Kenta Yagi  3 , Yuki Izawa-Ishizaka  8 , Momoyo Azuma  9 , Hiroaki Yanagawa  10 , Yoshikazu Tasaki  4 , Keisuke Ishizawa  1   2   3
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Free article

Concomitant Use of Multiple Nephrotoxins including Renal Hypoperfusion Medications Causes Vancomycin-Associated Nephrotoxicity: Combined Retrospective Analyses of Two Real-World Databases

Takashi Bando et al. Acta Med Okayama. 2023 Dec.
Free article

Abstract

There is a growing concern about the relationship between vancomycin-associated nephrotoxicity (VAN) and concomitant use of nephrotoxins. We examined this relationship by combined retrospective analyses of two real-world databases. Initially, the FDA Adverse Event Reporting System (FAERS) was analyzed for the effects of concomitant use of one or more nephrotoxins on VAN and the types of combinations of nephrotoxins that exacerbate VAN. Next, electronic medical records (EMRs) of patients who received vancomycin (VCM) at Tokushima University Hospital between January 2006 and March 2019 were examined to confirm the FAERS analysis. An elevated reporting odds ratio (ROR) was observed with increases in the number of nephrotoxins administered (VCM + one nephrotoxin, adjusted ROR (95% confidence interval [CI]) 1.67 [1.51-1.85]; VCM + ≥2 nephrotoxins, adjusted ROR [95% CI] 1.54 [1.37-1.73]) in FAERS. EMRs analysis showed that the number of nephrotoxins was associated with higher incidences of VAN [odds ratio: 1.99; 95% CI: 1.42-2.78]. Overall, concomitant use of nephrotoxins was associated with an increased incidence of VAN, especially when at least one of those nephrotoxins was a renal hypoperfusion medication (furosemide, non-steroidal anti-inflammatory drugs, and vasopressors). The concomitant use of multiple nephrotoxins, especially including renal hypoperfusion medication, should be avoided to prevent VAN.

Keywords: electronic medical records; nephrotoxin; polypharmacy; spontaneous adverse event reporting database; vancomycin-associated nephrotoxicity.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

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