Incidence and predictors of intravenous acyclovir-induced nephrotoxicity

Collection Location Koleksi E-book & E-Journal Perpustakaan Pusat Unila
Edition Vol. 37, Issue. 10
Call Number
ISBN/ISSN 1435-4373
Author(s) Richelsen, Rasmus K. B.
Jensen, Signe B.
Nielsen, Henrik
Subject(s) Biomedicine
Classification NONE
Series Title
GMD E-Journal
Language English
Publisher Springer
Publishing Year 2018
Publishing Place Switzerland
Abstract/Notes Abstract
To 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 renal 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 nephrotoxicity 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
range (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 predict whowill develop acyclovir-induced nephrotoxicity; itmay occur late in treatment and
hypertension was the only independent predictive factor, while the absence of co-morbidities was protective. Ensuring hydration,
frequent evaluations of renal function, and corresponding dose adjustment of intravenous acyclovir treatment seem prudent.
Keywords Acyclovir . Nephrotoxicity . Acute kidney injury . Herpes encephalitis
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