Multifactorial attribution for vancomycin-associated acute kidney injury.
Yu-Ling Tseng1, Chien-Chou Su2, Ching-Shiang Yang1
1Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
British Journal of Clinical Pharmacology
|April 29, 2026
Summary
Vancomycin use increases acute kidney injury (AKI) risk, especially with high concentrations. Concomitant medications like loop diuretics and certain antibiotics further modify this risk, necessitating personalized patient assessments.
Area of Science:
- Pharmacology
- Nephrology
- Clinical Pharmacy
Background:
- Vancomycin is crucial for severe gram-positive infections.
- Acute kidney injury (AKI) is a known vancomycin side effect.
- Real-world AKI risk factors in polypharmacy are not fully understood.
Purpose of the Study:
- Assess vancomycin exposure and AKI association.
- Identify heterogeneous AKI risk patterns in patient subgroups.
- Evaluate the impact of concomitant medications on vancomycin-associated AKI.
Main Methods:
- Retrospective analysis of adult vancomycin recipients (2019-2023).
- Logistic regression for trough concentration and AKI risk.
- X-Learner framework for conditional average treatment effect (CATE) analysis.
Main Results:
- 23.2% of 1611 patients developed AKI.
- Each 1 mg/L vancomycin trough increase raised AKI odds by 8%.
- High troughs (>15.5 mg/L) elevated AKI risk by 31% absolute.
- Co-administration of β-lactams (piperacillin, meropenem) and loop diuretics increased AKI risk.
Conclusions:
- Vancomycin-associated AKI risk is heterogeneous and influenced by concomitant medications.
- Loop diuretics, piperacillin, and meropenem significantly affect vancomycin-AKI association.
- Comprehensive risk assessment considering medication profiles is essential.
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