Carbapenem Renal Dose Discordance and Acute Kidney Injury in the Intensive Care Unit: A Retrospective Cohort Study
Nhi T. Quach, Ngoc H. B. Le, Tram T. M. Huynh, Giang H. H. Nguyen, Oanh H. H. Bui, Minh D. Tran, Tu T. C. Le, Thang NguyenBackground:
Renal function changes rapidly in the intensive care unit (ICU), and carbapenem dosing above renal-adjusted recommendations is a potentially preventable medication safety issue.
Objective:
To evaluate the association between carbapenem renal dose discordance and acute kidney injury (AKI); treatment failure was exploratory.
Methods:
This ethics-approved retrospective cohort included adults receiving carbapenems for at least 48 hours in a Vietnamese hospital ICU (January 2024-April 2026). Discordance was at least 1 day above renal-adjusted recommendations based on estimated Cockcroft-Gault creatinine clearance and clinical indication. Kidney Disease: Improving Global Outcomes criteria defined AKI. Robust Poisson regression estimated adjusted risk ratios (aRRs). Matched outcome models additionally adjusted for Glasgow Coma Scale category and septic shock. A post hoc Bonferroni threshold of α = .003125 was applied.
Results:
Of 490 patients, 78 (15.9%) had discordant dosing. Acute kidney injury occurred in 28/78 (35.9%) with discordant dosing versus 18/412 (4.4%) with concordant dosing. Discordance was associated with AKI in the primary analysis (aRR, 8.061; 95% confidence interval [CI], 4.135-15.714;
Conclusions:
Carbapenem renal dose discordance was associated with AKI, although causation cannot be established. Daily renal dose review by pharmacists is a practical medication safety target that warrants prospective evaluation.