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Abstract
Background
It has been suggested that the glomerular filtration rate can be predicted on the basis of serum cystatin C concentration. The aim of this study was to investigate the clinical utility of serum cystatin C as a marker of renal function and to evaluate the effect of an initial dose of vancomycin using serum cystatin C concentration in elderly patients.
Materials and Methods
Data was collected from July 2006 to September 2008. The subjects were elderly patients (≥60-years-of-age; n=number of patients) who had been treated with vancomycin. Serum concentrations of parameters including vancomycin, creatinine, and cystatin C were measured. Correlations between measured vancomycin concentrations and predicted vancomycin concentrations based on serum cystatin C or serum creatinine were compared, and the initial dose setting of vancomycin on the basis of serum cystatin C concentration was evaluated.
Results
Serum cystatin C was a good marker of renal function in comparison with serum creatinine for various doses of vancomycin in the elderly subject. In subpopulation (n=88) with normal serum cystatin C level (≤1.2 mg/L) who were treated with routine adult vancomycin dose (1g q 12 hours), vancomycin concentration was within the therapeutic range (5-15 mg/L) in 68 patients (77.3%), and was <20 mg/L in 77 of the 88 patients (88.5 %).
Figures and Tables
Figure 1
Correlations between measured and predicted vancomycin concentration on the basis of serum creatinine (A) and serum cystatin C (B).
Figure 2
Distribution of serum cystatin C concentration at normal range of serum creatinine concentration (≤1.0 mg/dL).
Figure 3
Distribution of serum creatinine concentration at normal range of serum cystatin C concentration (≤1.2 mg/L).
Table 1
Characteristics of Patients with Normal Cystatin C Level and Treated with Routine Adultdose of Vancomycin(n=88)
References
1. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976. 16:31–41.
2. Branten AJ, Vervoort G, Wetzels JF. Serum creatinine is a poor marker of GFR in nephrotic syndrome. Nephrol Dial Transplant. 2005. 20:707–711.
3. Verhave JC, Fesler P, Ribstein J, du Cailar G, Mimran A. Estimation of renal function in subjects with normal serum creatinine levels: influence of age and body mass index. Am J Kidney Dis. 2005. 46:233–241.
4. Rybak MJ, Albrecht LM, Boike SC, Chandrasekar PH. Nephrotoxicity of vancomycin, alone and with an aminoglycoside. J Antimicrob Chemother. 1990. 25:679–687.
5. Rybak MJ, Albrecht LM, Boike SC, Chandrasekar PH. Nephrotoxicity of vancomycin, alone and with an aminoglycoside. J Antimicrob Chemother. 1990. 25:679–687.
6. Filler G, Bökenkamp A, Hofmann W, Le Bricon T, Martínez-Brú C, Grubb A. Cystatin C as a marker of GFR--history, indications, and future research. Clin Biochem. 2005. 38:1–8.
7. Okamoto G, Sakamoto T, Kimura M, Ukishima Y, Sonoda A, Mori N, Kato Y, Maeda T, Kagawa Y. Serum cystatin C as a better marker of vancomycin clearance than serum creatinine in elderly patients. Clin Biochem. 2007. 40:485–490.
8. Christensson A, Ekberg J, Grubb A, Ekberg H, Lindström V, Lilja H. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation. Nephron Physiol. 2003. 94:19–27.
9. Pöge U, Gerhardt T, Stoffel-Wagner B, Klehr HU, Sauerbruch T, Woitas RP. Calculation of glomerular filtration rate based on cystatin C in cirrhotic patients. Nephrol Dial Transplant. 2006. 21:660–664.
10. Elliott TS, Foweraker J, Gould FK, Perry JD, Sandoe JA. Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2004. 54:971–981.
11. American Thoracic Society. Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005. 171:388–416.
12. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004. 39:1267–1284.
13. Wysocki M, Delatour F, Faurisson F, Rauss A, Pean Y, Misset B, Thomas F, Timsit JF, Similowski T, Mentec H, Mier L, Dreyfuss D. Continuous versus intermittent infusion of vancomycin in severe Staphylococcal infections: prospective multicenter randomized study. Antimicrob Agents Chemother. 2001. 45:2460–2467.
14. Tanaka A, Suemaru K, Otsuka T, Ido K, Nishimiya T, Sakai I, Hasegawa H, Inoue T, Murase M, Yasukawa M, Araki H. Estimation of the initial dose setting of vancomycin therapy with use of cystatin C as a new marker of renal function. Ther Drug Monit. 2007. 29:261–264.
15. Hermida J, Tutor JC. Serum cystatin C for the prediction of glomerular filtration rate with regard to the dose adjustment of amikacin, gentamicin, tobramycin, and vancomycin. Ther Drug Monit. 2006. 28:326–331.
16. Coll E, Botey A, Alvarez L, Poch E, Quintó L, Saurina A, Vera M, Piera C, Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis. 2000. 36:29–34.
17. Choi NW, Kim JH, Lee CS, Lee CH, Kim GH, Kang CM. Relationship between serum cystatin C and glomerular filtration rate in renal transplant patients. Korean J Med. 2006. 70:672–680.
18. Han KH, Han SY, Kang YS, Cha DR. Serum cystatin C concentration compared with serum creatinine concentration as a marker of glomerular filtration rate. Korean J Nephrol. 2006. 25:737–744.
19. Kollef MH. Limitations of vancomycin in the management of resistant Staphylococcal infections. Clin Infect Dis. 2007. 45:Suppl 3. S191–S195.
20. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adult patients receiving continuous renal replacement therapy. Clin Infect Dis. 2005. 41:1159–1166.
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