Vancomycin Clinical Trial
Official title:
A Randomized Clinical Trial of Continuous vs. Intermittent Infusion Vancomycin: Effects on Measured GFR and Kidney Injury Biomarkers
Hospitalized adult participants prescribed vancomycin by their treating physician will be randomized to receive vancomycin via continuous or intermittent infusion and measures of kidney function and injury will be collected.
Status | Recruiting |
Enrollment | 56 |
Est. completion date | December 2024 |
Est. primary completion date | December 2024 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - = 18 years of age - Hospitalized at University of Kentucky on a medical service (internal medicine or medical intensive care) - Prescribed = 2 doses of vancomycin per treating physician - Be able to provide written, informed consent, or have a legally authorized representative (LAR) responsible for their care able to provide written, informed consent. Exclusion Criteria: - Chronic kidney disease (documented or prior to admission estimated GFR (eGFR) <60 ml/min/1.73m2 using non-race-based creatinine GFR equation) - End stage kidney disease - Stage 1 or higher AKI per Kidney Disease: Improving Global Outcomes (KDIGO) classification (serum creatinine increase = 0.3 mg/dl or 1.5-1.9 times baseline; urine output < 0.5 ml/kg/hr for 6-12 hours) - Receipt of vancomycin within the last 72 hours (not considering the loading dose) - Allergy to iohexol - Uroepithelial tumors - Pregnancy - Prisoner |
Country | Name | City | State |
---|---|---|---|
United States | University of Kentucky | Lexington | Kentucky |
Lead Sponsor | Collaborator |
---|---|
Alexander Flannery | National Institute of Allergy and Infectious Diseases (NIAID) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Change in measured glomerular filtration rate (GFR) | measured via the administration of a small dose of iohexol followed by the collection of blood samples | Baseline (Day 0) and Day 3 | |
Primary | Change in urinary Kidney Injury Molecule 1 (KIM-1) | Measured by urine ELISA test as the change score | Baseline (Day 0) and Day 3 | |
Secondary | Plasma cystatin C over time | Measured by urine ELISA test at baseline, 48-, and 72-hours following the first dose of vancomycin.
Additional measure at 120 hours if the patient is prescribed vancomycin for 120 hours or more. |
Baseline up to 5 days | |
Secondary | Urine Clusterin over time | Measured by urine ELISA test at baseline, 48-, and 72-hours following the first dose of vancomycin. Additional measure at 120 hours if the patient is prescribed vancomycin for 120 hours or more. | Baseline up to 5 days | |
Secondary | Urine Osteopontin over time | Measured by urine ELISA test at baseline, 48-, and 72-hours following the first dose of vancomycin. Additional measure at 120 hours if the patient is prescribed vancomycin for 120 hours or more. | Baseline up to 5 days | |
Secondary | Urine Kidney Injury Molecule-1 (KIM-1) over time | Measured by urine ELISA test test at baseline, 48-, and 72-hours following the first dose of vancomycin. Additional measure at 120 hours if the patient is prescribed vancomycin for 120 hours or more. | Baseline up to 5 days | |
Secondary | Change in Urine Kidney Injury Molecule-1 (KIM-1) | Measured as the change score, only in the only in subset of patients prescribed 5 or more days of vancomycin | Baseline (Day 0) and Day 5 | |
Secondary | Vancomycin Area-Under-the-Curve (AUC) target attainment | Defined as range 400-600 mg*hr/L. AUC assessed using one concentration Bayesian estimates. | Day 1 | |
Secondary | Acute Kidney Injury (AKI) over time | Using serum creatinine and urine output components of Kidney Disease: Improving Global Outcome (KIDGO) classification | Daily up to 10 days | |
Secondary | Phlebitis over time | Monitored per standard of care, using phlebitis scores of 0 (no clinical symptoms) to 4. Documented scores above 0 will be classified as phlebitis. | Daily up to 7 days | |
Secondary | Infiltration over time | Monitored per standard of care, using infiltration scores of 0 (no clinical symptoms) to 4. Documented scores above 0 will be classified as infiltration. | Daily up to 7 days | |
Secondary | Acute Kidney Disease | measured per Acute Disease Quality Initiative (ADQI) criteria in a subset of participants where AKI does not resolve by 7 days | Until hospital discharge, up to 17 days | |
Secondary | Number of Participants with Major Adverse Kidney Events | Composite of death, requirement for kidney replacement therapy, or reduction of 25% from baseline estimated glomerular filtration rate. | Until hospital discharge, up to 17 days | |
Secondary | Change in measured glomerular filtration rate (GFR) | measured via the administration of a small dose of iohexol followed by the collection of blood samples, only in the subset of patients receiving vancomycin for 5 days | Baseline (Day 0) and Day 5 |
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