Evidence mapPaperPMID 40878006Full record

ArticlePharmacoepidemiology and drug safety2025

Vancomycin-Induced Acute Kidney Injury in Intensive Care Patients: A Target Trial Emulation Study Using Multicenter Routinely Collected Data.

Izak A R Yasrebi-de Kom, Kitty J Jager, Vianda S Stel, Nicholas C Chesnaye, Ameen Abu-Hanna, Nicolette F de Keizer, Dylan W de Lange, Dave A Dongelmans, Joanna E Klopotowska, Giovanni Cinà and 1 more

Abstract readMulticenter Study
In one paragraph

Article in Pharmacoepidemiology and drug safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Izak A R Yasrebi-de KomDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.ORCID https://orcid.org/0000-0002-8655-2521
Kitty J JagerDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Vianda S StelDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Nicholas C ChesnayeAmsterdam Public Health, Amsterdam, the Netherlands.
Ameen Abu-HannaDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Nicolette F de KeizerDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Dylan W de LangeDepartment of Intensive Care and Dutch Poison Information Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Dave A DongelmansAmsterdam Public Health, Amsterdam, the Netherlands.
Joanna E KlopotowskaDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Giovanni CinàDepartment of Medical Informatics, Amsterdam University Medical Center, Amsterdam, the Netherlands.
RESCUE Study Group

Funding

ZonMw 848018004
6 · The paper itself

Abstract

purposeThe potential of vancomycin to cause acute kidney injury (AKI) in adult intensive care patients is subject to debate due to suboptimal designs of past studies. Therefore, we aimed to estimate the effect of initiating vancomycin versus one of several minimally nephrotoxic alternative antibiotics on the 14-day risk of AKI using the target trial emulation framework.

methodsA hypothetical trial was emulated using routinely collected data from 15 Dutch intensive care units (ICUs) spanning 2010-2019. We used an active comparator control group with the following alternative antibiotics: clindamycin, linezolid, teicoplanin, meropenem, cefazolin, and daptomycin. AKI was diagnosed according to the KDIGO serum creatinine (SCr) criteria. Cumulative incidence curves were estimated using the Aalen-Johansen method and adjusted for confounding and selection bias through inverse probability of treatment and censoring weighting. Given the time lag of 24-48 h between changes in renal function and SCr, we summarized the estimates by calculating the absolute risks and risk differences at both 2 and 14 days after initiation.

resultsWe included 1809 ICU admissions. After adjustment, vancomycin was associated with a higher risk of AKI at 14 days of follow-up compared to the alternative antibiotics (0.28 [95% confidence interval (CI) 0.21-0.34] vs. 0.17 [95% CI 0.14-0.20]; risk difference 0.11 [95% CI 0.04-0.19]), but not at 2 days of follow-up (0.10 [95% CI 0.06-0.12] vs. 0.10 [95% CI 0.08-0.11]; risk difference 0.00 [95% CI -0.03-0.03]).

conclusionsOur findings indicate that vancomycin causes a higher risk of AKI compared to the alternative antibiotics. We recommend clinicians to be compliant with vancomycin-induced AKI prevention strategies, such as therapeutic drug monitoring or the consideration of an alternative antibiotic if possible.

Indexed as

Acute Kidney InjuryAnti-Bacterial AgentsIntensive Care UnitsVancomycinAdultAgedCreatinineCritical CareFemaleHumansIncidenceMaleMiddle AgedNetherlandsAnti-Bacterial AgentsCreatinineVancomycinacute kidney injuryadverse drug eventintensive caretarget trial emulationvancomycin

Identifiers

PMID40878006
PMCPMC12394726

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.