From the Research
Amikacin can cause acute kidney injury (AKI) within a minimum duration of 5-7 days of initiating therapy, though it may occur earlier in patients with risk factors. The risk of nephrotoxicity increases with longer duration of treatment, higher doses, and concurrent use of other nephrotoxic medications. Amikacin, an aminoglycoside antibiotic, causes damage to the proximal tubular cells in the kidneys through accumulation in the renal cortex, disrupting cellular function and leading to tubular necrosis.
Key Points
- Risk factors that may accelerate kidney injury include pre-existing renal impairment, advanced age, dehydration, and concomitant use of other nephrotoxic agents.
- To minimize the risk of AKI, therapeutic drug monitoring is essential, with target peak levels of 20-30 mg/L and trough levels below 5-10 mg/L, as suggested by 1.
- Once-daily dosing (rather than multiple daily doses) and ensuring adequate hydration can help reduce nephrotoxicity risk.
- Regular monitoring of renal function through serum creatinine and estimated glomerular filtration rate is recommended during amikacin therapy, as indicated by 2.
Duration of Treatment
The mean duration of treatment in the study by 2 was 12.09 days, with an incidence rate of amikacin-induced nephrotoxicity of 1.076/person-year. However, the exact minimum duration required for amikacin to cause AKI is not explicitly stated in the study.
Dosing and Monitoring
A study by 3 proposed an initial dosing approach for amikacin to optimize the a priori pharmacokinetic/pharmacodynamic target attainments in individual patients. The study suggested that a dose of 23.4 mg/kg could achieve a peak concentration of ≥64 mg/L in 53% of patients.