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Vancomycin-associated acute kidney injury epidemiology in children: a systematic review
  1. Chloe Williams1,2,
  2. Charlotte Hankinson1,2,
  3. Stephen J McWilliam2,
  4. Louise Oni2,3
  1. 1 School of Medicine, University of Liverpool, Liverpool, UK
  2. 2 Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK
  3. 3 Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Louise Oni, Department of Women’s and Children’s Health, University of Liverpool, Liverpool, UK; louise.oni{at}


Introduction Vancomycin is a recognised cause of drug-induced acute kidney injury (AKI).

Objective The aim of this systematic review was to summarise the incidence of, and the risk factors for, vancomycin-associated AKI (v-AKI) in children.

Design A systematic search was performed in November 2020 on the search engines PubMed, Web of Science and Medline, using predefined search terms. The inclusion criteria were primary paediatric studies, intervention with vancomycin and studies that included AKI as an outcome. Study quality was assessed using the relevant Critical Appraisal Skills Programme checklist. The data are reported using descriptive statistics.

Results 890 studies were identified and screened with 25 studies suitable for inclusion. A cohort of 12 730 patients with v-AKI were included and the incidence of v-AKI in children was found to be 11.8% (1.6%–27.2%). The median age of the cohort was 2.5 years (range 0–23) and 57% were male patients. Risk factors that increased the likelihood of v-AKI were concomitant use of nephrotoxic medications, increased trough concentrations and, to a lesser extent, increased dose, longer duration of treatment, impaired renal function and if the patient required paediatric intensive care.

Conclusions The incidence of v-AKI in children is significant and methods to reduce this risk should be considered. Further prospective interventional studies to understand the mechanisms of nephrotoxicity from vancomycin are needed and targeting risk factors may make vancomycin administration safer.

  • nephrology
  • paediatrics
  • pharmacology
  • therapeutics
  • toxicology

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  • SJM and LO are joint senior authors.

  • Twitter @charlhankinson1, @DrSteveMc

  • Contributors CW designed and performed the literature search and was the main contributor in writing the manuscript. CH performed the second independent literature search. Both CW and CH screened the abstracts and titles against the eligibility criteria. SMcW and LO supervised and contributed to the writing of the manuscript, and are jointly responsible for the overall content as the guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.