Q J Med 2002; 95: 291-297
© 2002 Association of Physicians
Risk factors for nephrotoxicity in elderly patients receiving once-daily aminoglycosides
1 From the Infectious Diseases Unit, 2 Department of Geriatrics, and 4 Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, affiliated with the Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er-Sheba, and 3 Department of Public Health, Hebrew University Hadassah Medical School, Jerusalem, Israel
Received 30 August 2001 and in revised form 28 January 2002
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) (p<0.001); haemoglobin level <10 g/dl (p<0.05); hospital admission >7 days prior to AG treatment (p<0.005); and AG treatment 11 days (p<0.05). Mean CrCl based on estimated weight was 52±18 ml/min; that based on actual weight was 71±37 ml/min. Despite this, mean AG dose was 1.3±0.6 higher than optimal.
Conclusions: 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.
Address correspondence to Dr A.M. Yinnon, Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel. e-mail: Yinnon{at}SZMC.org.il
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