Safety of vancomycin in patients with moderate and severe renal dysfunction

Area of Science:

• Pharmacology
• Nephrology
• Infectious Diseases

Background:

• New Japanese guidelines recommend against vancomycin (VCM) loading doses for patients with moderate (eGFR 30-80 mL/min/1.73m²) or severe (eGFR <30 mL/min/1.73m²) renal dysfunction.
• The safety and efficacy of VCM in these patient groups under the new guidelines require investigation.

Purpose of the Study:

• To evaluate the safety and effectiveness of vancomycin (VCM) in patients with moderate and severe renal dysfunction according to new Japanese guidelines.
• To assess VCM trough concentrations and the incidence of acute kidney injury (AKI) in these patient populations.

Main Methods:

• Retrospective analysis of 64 patients with eGFR < 80 mL/min/1.73m² treated with VCM between April 2014 and March 2018.
• Monitoring of VCM trough concentrations and renal function (serum creatinine) pre- and post-administration.
• Primary endpoints included achieving a target VCM trough concentration (10-20 µg/mL) and the rate of acute kidney injury (AKI).

Main Results:

• The mean VCM trough concentration was 9.3 µg/mL in moderate and 11.6 µg/mL in severe renal dysfunction groups.
• Effective trough concentrations were achieved in 50% (severe) and 43% (moderate) of patients.
• No significant difference in AKI rates was observed between groups, though the severe group showed a slight improvement in serum creatinine.

Conclusions:

• Current vancomycin (VCM) dosing strategies may lead to suboptimal trough concentrations in patients with moderate to severe renal dysfunction.
• Dose escalation and careful monitoring of VCM trough levels and renal function are recommended, particularly for patients with severe renal dysfunction.