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Optimising Therapeutic Target Attainment in Vancomycin Therapy for Patients Requiring Intermittent Haemodialysis
Danny Tsai1,2,3, María Patricia Hernández-Mitre3, Amy Legg3
1Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia.
Nephrology (Carlton, Vic.)
|June 29, 2026
Summary
Optimized vancomycin dosing for intermittent haemodialysis (iHD) patients is crucial. This study provides a weight-based dosing nomogram to improve vancomycin therapy effectiveness in iHD patients.
Area of Science:
- Pharmacokinetics
- Clinical Pharmacy
- Nephrology
Background:
- Vancomycin is essential for treating Gram-positive infections.
- Intermittent haemodialysis (iHD) alters drug pharmacokinetics, complicating vancomycin dosing.
- Optimized vancomycin regimens are needed for iHD patients to ensure efficacy and minimize toxicity.
Purpose of the Study:
- To characterize vancomycin pharmacokinetics in patients undergoing iHD.
- To develop evidence-based dosing guidance for a three-times-weekly vancomycin regimen post-iHD.
- To improve pharmacokinetic/pharmacodynamic target attainment (PTA) in this patient population.
Main Methods:
- Population pharmacokinetic analysis of retrospectively collected vancomycin concentrations from iHD patients.
- Utilized Monolix software for pharmacokinetic modeling.
- Simulated probability of target attainment (PTA) for various dosing strategies.
Main Results:
- Actual body weight was the primary covariate influencing vancomycin pharmacokinetics.
- Weight-based loading doses were supported by simulations.
- Dosing intervals and pre-iHD trough concentrations significantly impacted maintenance dose PTA.
Conclusions:
- A vancomycin dosing nomogram for iHD patients was proposed.
- Weight-based loading doses are recommended.
- Prospective validation of the proposed nomogram is warranted.
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