Incidence and predictors of intravenous acyclovir-induced nephrotoxicity

AbstractTo assess the incidence, predictive factors, and prognosis of acyclovir-induced nephrotoxicity. We conducted a historical prospective cohort study of patients treated with intravenous acyclovir in North Denmark Region from 2009 to 2016. Information on baseline demographics, co-morbidities, plasma creatinine, and treatment was obtained from the medical records. The primary outcome was an increase of ≥ 40 μmol/L in plasma creatinine level from baseline. We included 276 patients treated with intravenous acyclovir of which 29 (10.5%) met the primary outcome. In 14 cases, the treating physician considered acyclovir the main reason for nephrotoxicity, whereas a potential competing cause of ren al impairment was present among the 15 remaining patients. Hypertension was the only predictive factor associated with nephrotoxicity (risk ratio (RR), 2.77; 95% confidence interval (CI), 1.41–5.46), while having no co-morbidities was protective (RR, 0.32; CI, 0.16–0.63). In all cases, the nephr otoxicity was reversible following rehydration and dose reduction or discontinuation of the drug. However, the normalized plasma creatinine upon treatment was significantly higher between cases with acyclovir-induced nephrotoxicity than cases with a potential competing cause (median [interquartile r ange (IQR)], 93.5 μmol/L [85–108] vs 75 μmol/L [66.5–88];p = 0.019). Acyclovir-induced, reversible nephrotoxicity was observed in 5.1–10.5% of patients. It is difficult to p...
Source: European Journal of Clinical Microbiology and Infectious Diseases - Category: Microbiology Source Type: research