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Vancomycin exposure in critically ill children undergoing high intensity continuous renal replacement therapy
Victor Belliard1, Naim Bouazza2, Baptiste Grenier3,4
1Réanimation Et Soins Intensifs Polyvalents Pédiatriques - SMUR Pédiatrique, AP-HP. Centre, Hôpital Necker-Enfants Malades, 75015, Paris, France. victor.belliard@aphp.fr.
Pediatric Nephrology (Berlin, Germany)
|July 7, 2026
Summary
Critically ill children on continuous renal replacement therapy (CRRT) face higher vancomycin underexposure risks. Factors like effluent flow rate significantly impact drug concentrations, necessitating therapeutic drug monitoring (TDM) for optimized dosing.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Pharmacokinetics
Background:
- Vancomycin is crucial for treating severe pediatric infections.
- Continuous renal replacement therapy (CRRT) alters drug clearance.
- Understanding vancomycin pharmacokinetics in pediatric CRRT is essential.
Purpose of the Study:
- To describe vancomycin concentrations in critically ill children undergoing CRRT.
- To identify factors influencing vancomycin levels during CRRT.
Main Methods:
- Retrospective monocentric study of children under 18 on CRRT (2020-2023).
- Collected demographic, clinical, and vancomycin data, including CRRT parameters.
- Analyzed vancomycin concentration associations using linear mixed modeling.
Main Results:
- Vancomycin underexposure was more frequent in children on CRRT (54%) versus off CRRT (37%).
- Lower vancomycin concentrations were observed during CRRT.
- Factors decreasing exposure included lower body weight, higher effluent flow rate, urine output, and lower hematocrit.
Conclusions:
- Children on CRRT are at increased risk of vancomycin underexposure.
- CRRT flow rates, especially effluent flow rate, significantly impact vancomycin levels.
- Therapeutic drug monitoring and pharmacokinetic modeling are recommended for individualized vancomycin dosing in pediatric CRRT.
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