Analysis of vancomycin administration to patients with one kidney

When one kidney is lost, the other works to compensate. The renally excreted antibiotic vancomycin (VCM) requires therapeutic drug monitoring to avoid renal injury and ensure efficacy. However, no studies have clarified whether the dosing regimen for patients with two kidneys can be used in patients with one kidney. We investigated whether patients with one kidney are able to receive VCM with the same dosing regimen as patients with two kidneys.

This retrospective case series included patients with one kidney who were treated with VCM at Chiba University Hospital. Changes in serum creatinine (Scr) values and VCM trough concentrations were assessed. To evaluate individual VCM pharmacokinetic (PK) parameters in patients with one kidney, we performed Bayesian estimation using two population PK models for Japanese patients with two kidneys.

Six patients with one kidney were included in this study. The median loading dose and maintenance dose were 20.6 mg/kg and 28.3 mg/kg/day, respectively. Scr showed little change from before to after VCM administration (before, median 0.93 [0.72-1.32] mg/dL; after, 0.85 [0.69-1.22] mg/dL), and no patients developed VCM-associated nephrotoxicity. The trough concentration of VCM remained within the effective blood range of 10-20 μg/mL in almost all patients. There was a significant and strong correlation between the observed and Bayesian-estimated VCM trough concentrations for both population PK models.

Patients with one kidney may be able to receive VCM with the same dosing regimen as patients with two kidneys.