Kidney Week

Abstract: FR-OR66

Nuclear Magnetic Resonance-Based Glomerular Filtration Rate Estimation Is More Closely Associated with Serum Vancomycin Target Trough Achievement vs. Serum Creatinine-Based Equations

Session Information

• Innovative AKI Strategies and Drug Discoveries
  October 25, 2024 | Location: Room 7, Convention Center
  Abstract Time: 04:50 PM - 05:00 PM

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

• 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

• Barreto, Jason N., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Jason N. Barreto, PharmD

• Schwäble Santamaría, Amauri, Numares, Regensburg, Germany

Amauri Schwäble Santamaría

• Grassi, Marcello, Numares, Regensburg, Germany

Marcello Grassi, MSc

• Robertson, Andrew, Numares, Regensburg, Germany

Andrew Robertson, MBChB, MSc

• Lieske, John C., Mayo Clinic Minnesota, Rochester, Minnesota, United States

John C. Lieske, MD, FASN

• Meeusen, Jeff W., Numares, Regensburg, Germany

Jeff W. Meeusen, PhD

• Schiffer, Eric, Numares, Regensburg, Germany

Eric Schiffer, PhD

• Barreto, Erin F., Mayo Clinic Minnesota, Rochester, Minnesota, United States

Erin F. Barreto, PharmD, MS, FASN

Background

The clinical utility of glomerular filtrate rate (GFR) estimation based on a panel of analytes (creatinine, cystatin C, myoinositol and valine) measured by nuclear magnetic resonance spectroscopy (GFR_NMR) as compared to standard eGFR equations based on serum creatinine for patients receiving vancomycin is unclear.

Methods

This prospective, single-center study included consecutive adults prescribed intravenous vancomycin at Mayo Clinic in Rochester, MN, from 2022 to 2024. Vancomycin indication, dose, frequency, and goal concentration range were determined by the clinical care team. Pearson’s product-moment correlation analysis and ordinary least squares regression techniques were used to compare GFR estimating equations as predictors of serum vancomycin trough concentration, accounting for relevant covariates.

Results

66 patients were enrolled. The median (IQR) age was 61 (50, 70) years, 45 (68%) were male, and 59 (89%) were non-Hispanic White individuals. Vancomycin was most often prescribed for skin, soft tissue, or musculoskeletal infections (n=24, 32%). Thirty-five (53%) patients had a steady state trough concentration within the goal range of 10-20 mg/L. Seven (11%) patients had troughs > 20 mg/L and six (9%) patients developed AKI within seven days of vancomycin initiation. Both GFR_NMR and CKD-EPI 2021_Cr were negatively correlated with vancomycin concentrations (GFR_NMR: t₆₄ = -6.81, p-value < 0.001, r = -0.65 [-0.77, -0.48]; CKD-EPI 2021_Cr: t₆₂ = -4.22, p-value < 0.001, r = -0.47 [-0.64, -0.26]). In multivariable analyses, the GFR_NMR inclusive model for prediction of vancomycin trough concentrations had a higher adjusted R² (mean [95%CI]) 0.51 [0.45, 0.6] than the CKD-EPI 2021_Cr inclusive model at 0.34 [0.29, 0.4] (p-value = 0.008).

Conclusion

Vancomycin trough prediction models with GFR_NMR were more predictive than models with CKD-EPI 2021_Cr in hospitalized patients. Future research should evaluate the potential for GFR_NMR to guide individualized vancomycin dosing.

Funding

• Commercial Support – Numares