Unmet targets: evaluating vancomycin use and predictive factors of target attainment in hemodialysis patients

Vancomycin is commonly prescribed in hemodialysis (HD) patients, who are highly susceptible to infections. Although HD-specific dosing targets have recently emerged, considerable practice variability persists, highlighting the need to standardize vancomycin therapeutic drug monitoring (TDM).

This multicenter retrospective study describes local practice of vancomycin dosing and monitoring, measures attainment of vancomycin target concentration range (trough: 15-20 mg/L), and identifies predictors of attainment of TDM target in HD patients. Data was collected from patients on chronic intermittent high-flux HD who received vancomycin in two Canadian health centers from 1 January 2019 to 31 December 2022.

453 treatment courses, corresponding to 261 patients, were analyzed. Target attainment varied in both centers. The median (IQR) target attainment during a treatment course was 16.7% (0-50%) across all courses. Residual diuresis (OR = 0.48, 95% CI [0.28, 0.83]) and shorter treatment duration (OR = 0.91, 95% CI [0.87, 0.97]) were associated with worse target attainment.

This study highlights the high rate of 0% target trough concentration attainment per treatment course in our centers and identifies patients with residual diuresis and/or early stages of treatment (less than 7 days) as populations that may benefit from closer vancomycin TDM.