OPTIMIZING AMINOGLYCOSIDE DOSING IN CHRONIC KIDNEY DISEASE AND END-STAGE RENAL DISEASE PATIENTS UNDERGOING INTERMITTENT HEMODIALYSIS: CARDIOVASCULAR IMPLICATIONS AND CLINICAL OUTCOMES
Main Article Content
Keywords
Chronic kidney disease (CKD), End-stage renal disease (ESRD), Intermittent hemodialysis, Aminoglycosides, Therapeutic drug monitoring, Individualized dosing, Nephrotoxicity, Cardiovascular complications,
Abstract
Introduction:Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) undergoing intermittent hemodialysis frequently require aminoglycoside therapy for severe bacterial infections. Altered pharmacokinetics in renal dysfunction increase the risk of drug accumulation, nephrotoxicity, ototoxicity and cardiovascular complications associated with electrolyte imbalance, volume overload, systemic infection. Optimizing aminoglycoside dosing is therefore essential to improve both renal and cardiovascular outcomes. Methodology:A cross-sectional study was conducted among 220 adult CKD and ESRD patients receiving intermittent hemodialysis who were prescribed aminoglycosides at tertiary care hospital. Demographic characteristics, comorbidities, dialysis-related factors, aminoglycoside dosing regimens, therapeutic drug monitoring, renal function parameters, cardiovascular status and clinical outcomes were recorded using a structured data collection form. Descriptive statistics and multivariable logistic regression were used to identify factors associated with favorable clinical outcomes, with statistical significance set at p < 0.05. Results:The mean age of participants was 58.7 ± 13.2 years, and 61.8% were male. Therapeutic drug monitoring-guided dosing was implemented in 54.5% of patients and was associated with significantly higher treatment success (82.5% vs. 67.3%, p = 0.003), lower aminoglycoside-associated toxicity (11.7% vs. 25.8%, p = 0.009) and fewer cardiovascular complications including arrhythmias, intradialytic hypotension and heart failure exacerbations (18.3% vs. 31.4%, p = 0.018). Independent predictors of favorable outcomes included individualized dosing according to dialysis schedule (adjusted OR = 2.41, 95% CI: 1.35–4.29), therapeutic drug monitoring (adjusted OR = 2.76, 95% CI: 1.52–5.02) and preserved residual renal function (adjusted OR = 1.89, 95% CI: 1.08–3.30). Conclusion:Individualized aminoglycoside dosing strategies based on renal function, dialysis timing and therapeutic drug monitoring were associated with improved treatment efficacy, reduced nephrotoxicity and cardiovascular complications in CKD and ESRD patients undergoing intermittent hemodialysis. Incorporating a multidisciplinary cardio renal approach may further optimize antimicrobial therapy and improve clinical outcomes in this high-risk population.
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Saad Muzaffar Azeem
Senior Registrar Nephrology, Armed forces hospital Southern Region, Khamis Mushayt, KSA
Sadia Azeem
Nephrology Fellow , FCPS
Tashfa Ashfaque
Post graduate Resident, JPMC Hospital Karachi
Khadijah Siddiq
Resident Cardiology, PNS Shifa
Muhammad Omar Kamran
Final year student, Alatoo International University
Munawar Khursheed
Professor, National Institute of cardiovascular Diseases (NICVD), Karachi
Aiman Mehmood
MBBS graduate, Al tibri medical college, Karachi
Hamza Arshad
MBBS graduate, Al tibri medical college, Karachi
Zainab Zahid
Fourth year student, MBBS, Al Nafees Medical College, Islamabad
Tayyaba Ghani
MBBS graduate, Al tibri medical college, Karachi
Sonia Khan
Associate Professor, Islam Medical and Dental College.
