Serum Cystatin C Is a Major Predictor of Vancomycin Clearance in a Population Pharmacokinetic Analysis of Patients with Normal Serum Creatinine Concentrations.
10.3346/jkms.2013.28.1.48
- Author:
Jae Yong CHUNG
1
;
Sung Joon JIN
;
Ji Hyun YOON
;
Young Goo SONG
Author Information
1. Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Bundang Hospital, Seongnam, Korea.
- Publication Type:Original Article
- Keywords:
Vancomycin;
Cystatin C;
Pharmacokinetics;
NONMEM;
TDM
- MeSH:
Adolescent;
Adult;
Age Factors;
Aged;
Aged, 80 and over;
Anti-Bacterial Agents/blood/*pharmacokinetics;
Biological Markers/blood;
Body Weight;
Creatinine/*blood;
Cystatin C/*blood;
Demography;
Female;
Humans;
Male;
Middle Aged;
Models, Statistical;
Sex Factors;
*Software;
Vancomycin/blood/*pharmacokinetics;
Young Adult
- From:Journal of Korean Medical Science
2013;28(1):48-54
- CountryRepublic of Korea
- Language:English
-
Abstract:
We developed a population pharmacokinetic model of vancomycin by integrating the effects of cystatin C and other demographic factors in a large population of Korean patients with normal serum creatinine concentrations to elucidate the precise role of serum cystatin C concentrations in the prediction of vancomycin clearance. A population pharmacokinetic model of vancomycin was developed using NONMEM software from a total of 1,373 vancomycin concentration measurements in 678 patients whose serum creatinine concentrations were lower than 1.2 mg/dL. Covariate selection revealed that cystatin C was the most influential factor and had negative influence (-0.78) in the relationship. Total body weight, sex, age, and serum creatinine were also significantly correlated with the clearance. The estimated intersubject variabilities of clearance and volume of distribution were 24.7% and 25.1%, respectively. A 14-fold difference in predicted trough concentrations was observed according to only cystatin C concentrations in a population of simulated individuals with median demographic characteristics. The use of serum cystatin C as marker of vancomycin clearance for more accurate predictions of serum vancomycin concentrations could be useful, particularly among patients with normal serum creatinine concentrations.
