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GERIATRICS

Aminoglycoside-Associated Nephrotoxicity in the Elderly

Clinical Specialist — Medicine, Department of Pharmacy Services, University Hospitals of Cleveland; Assistant Clinical Professor of Pharmacy in Medicine, Case Western Reserve University, Cleveland, OH

Denise R Sokos, PharmD BCPS

Clinical Coordinator, Internal Medicine, University of Pittsburgh Medical Center Presbyterian; Assistant Professor of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

Ronald I Cowan, PharmD

Assistant Director of Clinical and Drug Information Services, Department of Pharmacy Services, University Hospitals of Cleveland; Assistant Instructor of Pharmacy in Medicine, Case Western Reserve University

Reprints not available.

OBJECTIVE: To determine whether there was an increased incidence of nephrotoxicity in elderly patients (65 y) prescribed single-dose (SD) versus multiple-dose (MD) aminoglycosides and whether aminoglycoside-induced nephrotoxicity was associated with length of therapy and other risk factors.

METHODS: A prospective, observational audit at a university teaching hospital was conducted. Physician prescribing was used to stratify subjects according to dosing regimen: MD (n = 60) or SD (n = 26). Nephrotoxicity was defined as an increase in the serum creatinine level of 0.5 mg/dL sustained over 2 days.

RESULTS: Eighty-six patients were included; 9.3% developed nephrotoxicity, of whom 62.5% received SD therapy. The incidence of nephrotoxicity did not differ between regimens (p = 0.051). There was an increased length of therapy in those who developed nephrotoxicity (mean ± SD 6.1 ± 6.2 vs. 3.7 ± 2.8 d; p = 0.044). Additionally, patients who developed nephrotoxicity had an increased length of hospitalization (20.3 ± 16.1 vs. 8.4 ± 5.4 d; p < 0.001). Nephrotoxicity correlated with a diagnosis of diabetes mellitus (OR 15.1; 95% CI 1.11 to 205), concomitant angiotensin-converting enzyme (ACE) inhibitor therapy (OR 28.0; 95% CI 2.15 to 365), and SD therapy (OR 20.7; 95% CI 1.45 to 297).

CONCLUSIONS: Our overall incidence of nephrotoxicity is consistent with that reported in the literature. A diagnosis of diabetes mellitus, concomitant use of ACE inhibitors, and SD regimens were risk factors for the development of nephrotoxicity. An adequately powered, randomized trial is needed to assess whether a difference in the incidence of nephrotoxicity exists between SD and MD therapy in the elderly.

Key Words: aminoglycosides, elderly, multiple dose, nephrotoxicity, single dose

Published Online, December 30, 2002. www.theannals.com, DOI

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