Renal function affects the plasma concentration and hematological toxicity of linezolid in elderly patients: a propensity-matched cohort analysis.

BACKGROUND

The relationships of renal function with linezolid trough concentration (Cmin) and hematological toxicity have not been clarified in elderly patients.

METHODS

In this propensity-matched cohort analysis, elderly patients receiving linezolid at four tertiary hospitals in Beijing between May 2021 and March 2024 were included. The patients were grouped by renal function and propensity score matching (PSM) was used to balance baseline characteristics. Linezolid Cmin and hematological indices were monitored dynamically.

RESULTS

Among 320 patients, 152 were eventually enrolled after PSM, including 56 (36.8%) patients with normal renal function (RN) and 96 (63.2%) patients with renal dysfunction (RD). Cmin at 3–5 (12.5 mg/L vs. 21.2 mg/L, P = 0.001) and 6–10 days (14.8 mg/L vs. 27.4 mg/L, P < 0001) was significantly lower in the RN group. The risk of linezolid-associated thrombocytopenia (LAT) and linezolid-associated anemia (LAA) in the RD group was 4.485 folds and 2.308 folds higher than in the RN group. The decreases in hematological indices were significantly higher in RD group than in RN group.

CONCLUSIONS

Renal function significantly affected linezolid Cmin and hematological toxicity, and the dose of linezolid should be reduced in elderly patients with renal dysfunction. TRIAL REGISTRATION: ChiCTR2100045707; Registration Date: 23/04/2021.