University of Kentucky College of Pharmacy, Lexington, KY, and University of Kentucky HealthCare, Lexington, KY.
Texas Tech University Health Sciences Center, Dallas, TX, and Dose Optimization and Outcomes Research (DOOR) program, Dallas, TX.
Am J Health Syst Pharm. 2019 Aug 1;76(16):1211-1217. doi: 10.1093/ajhp/zxz120.
Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin-tazobactam and vancomycin are reported.
A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science's Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded.
A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28-1.66]).
Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin-tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.
报告了一项研究结果，该研究旨在确定接受哌拉西林他唑巴坦和万古霉素联合治疗的患者中，肥胖是否与急性肾损伤（AKI）相关。
使用肯塔基大学临床与转化科学中心企业数据信托的数据，进行了一项回顾性、单中心队列研究，纳入至少接受 48 小时联合治疗的患者。排除患有慢性肾脏病、基线肌酐清除率低于 30 mL/min、囊性纤维化或身高或体重信息缺失的患者。
共有 8125 例患者纳入队列。在所评估的变量中，91kg 或以上的总体重是预测 AKI 的最具预测性的变量。体重为 91kg 或以上的患者比低体重患者更有可能患有糖尿病（39%比 21%，p<0.00001）、高血压（64%比 47%，p<0.00001）和心力衰竭（15%比 13%，p=0.007）。体重低于 91kg 的患者的万古霉素日剂量中位数较低（2000mg 比 3000mg，p<0.00001）；然而，体重为 91kg 或以上的患者的剂量较低（25.5mg/kg/天比 27.9mg/kg/天，p<0.00001）。体重为 91kg 或以上的患者 AKI 更常见（24%比 18%，p<0.00001；调整后的优势比，1.46[95%置信区间，1.28-1.66]）。
在同时接受哌拉西林他唑巴坦和万古霉素治疗的患者中，总体重增加会增加 AKI 的发生率，独立于重要的临床混杂因素，重要的临界点发生在 91kg。
