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Acute kidney injury (AKI) associated with intravenous aciclovir in adults: incidence and risk factors in clinical practice

Lookup NU author(s): Jonathan Foster, Dr Christopher Duncan



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


Objectives This study sought to identify the incidence of, and risk factors for, acute kidney injury (AKI) in adults treated with parenteral aciclovir. Methods A single-centre retrospective cohort study of prospectively acquired electronic clinical, pharmacy and laboratory data was performed with approval of the Caldicott guardian. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria, prior to analysis of baseline patient and treatment-related risk factors. Results 269 aciclovir treatment episodes were identified in 268 patients. Overall incidence of AKI was 13%. Half of AKI episodes were KDIGO grade 2/3. In univariate analysis, AKI occurred more frequently in patients with pre-existing chronic kidney disease (CKD), diabetes, and in patients treated with higher daily doses of aciclovir. There was also a trend to increased age in patients with AKI. In a binomial logistic regression model only CKD and daily dose remained significant independent factors. Conclusions AKI is an important side effect of parenteral aciclovir, the incidence of which is comparable to established nephrotoxic drugs such as aminoglycosides. Patients with pre-existing chronic kidney disease or receiving higher total doses are at greatest risk, reinforcing the clinical importance of appropriate dose adjustment for ideal body weight and baseline renal function.

Publication metadata

Author(s): Ryan L, Heed A, Foster J, Valappil M, Schmid ML, Duncan CJA

Publication type: Article

Publication status: Published

Journal: International Journal of Infectious Disease

Year: 2018

Volume: 74

Pages: 97-99

Print publication date: 01/09/2018

Online publication date: 07/07/2018

Acceptance date: 02/07/2018

Date deposited: 21/07/2018

ISSN (print): 1201-9712

ISSN (electronic): 1878-3511

Publisher: Elsevier Ltd


DOI: 10.1016/j.ijid.2018.07.002


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