Abstract
Objectives: To evaluate the minimum plasma concentrations of vancomycin (trough) for the first time in pediatric kidney transplant patients admitted to a tertiary hospital, and correlate them with various variables of clinical interest.
Methods: Retrospective observational study of the first troughs of each kidney transplant patient over 10 years (1/2012 - 12/2022). Therapeutic range: 10 to 20 mcg/ ml. Variables studied: age, sex, weight, height, body mass index (BMI), body surface area (BSA), vancomycin dosage, serum creatinine and albumin, and concomitant medication. Multiple linear regression analysis (R v4.0.4). Tests of normality (visual graphic inspection and the Shapiro-Wilk test), and of linearity, absence of collinearity, homoscedasticity, normality of residuals and independence of data for the final model, obtained by a backward step by step method according to Akaike information criteria (p < 0.05).
Results: 72 patients selected; age: 12 ± 4.1 years, sex: 51% female, weight: 31.0 ± 14.0 kg, height: 127.3 ± 21.0 cm, BMI: 18.34 ± 3.77 kg/m2, BSA: 1.0 ± 0.3 m2. 66.7% showed troughs outside the therapeutic range (81.1% subtherapeutic). Dose used: 560 ± 471.8 mg/ day (17.6 ± 11.3 mg/kg/day). Difference (days) between first dose and first trough: 2.0 ± 2.4. Median (range) of troughs: 8.5 ug/mL (0.4-69.6) %CV: 93.2. The BSA significantly affected the trough values (p < 0.05), being retained in the final model. Patients with BSA < 1 m2 presented significantly smaller troughs than those with BSA > 1 m2 (medians of 7.6 vs 9.9 mcg/ml, respectively).
Conclusions: The trough values showed wide dispersion; 66.7% of them entered the therapeutic range (similar to the patient population of our hospital: 69%). Since delaying an adequate adjustment of vancomycin dosage can negatively affect its therapeutic results, considering BSA could be important when instituting the initial vancomycin dosage in these types of critically ill patients.
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