Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides

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Abstract
Background: There remain concerns about the safety of once‐daily dosing of aminoglycosides (AGs) in the elderly. Aim: To assess the safety of once‐daily AGs in elderly patients and evaluate possible risk factors for nephrotoxicity. Design: Prospective, non‐interventional surveillance study. Methods: All patients receiving AGs were monitored over 4 months. Clinicians determined the AG dose for each patient after estimating patient weight and calculating creatinine clearance (CrCl) using the Cockcroft‐Gault formula. Parallel figures were calculated by the investigators using measured weight. Clinicians obtained an AG trough level 24 h after initiation of treatment, and, if non‐toxic, every 5–7 days thereafter. AG toxicity was defined as an increase in serum creatinine of ⩾50%. Results: In the study period, 249 consecutive patients received an AG: 116 (47%) males, mean±SD age 75±16 years. Forty‐two (17%) received amikacin and 207 (83%) gentamicin. An increase of ⩾50% in serum creatinine was detected in 31/249 (12.4%); maximal creatinine was ⩽177 μmol/l in 16/249 (6.4%), 186–265 μmol/l in nine (3.6%), and >265 μmol/l in six (2.4%). None developed oliguric renal failure. Renal damage correlated with a high AG trough level (>1.1 μg/ml) (pp7 days prior to AG treatment (ppConclusions: Oliguric and/or lasting renal toxicity is rare in elderly patients receiving once‐daily aminoglycosides for <11 days, if regular trough drug levels are monitored.
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