Related Experiment Videos

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
PubMed

Insights

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.
Abstract

Keywords:
Acute kidney injuryAntibioticDialysisFiltrationInfectionIntensive care unitPharmacokinetics

Related Concept Videos

Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Renal Failure: Dose Adjustments01:11

Renal Failure: Dose Adjustments

In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Drug Accumulation During Multiple Dosing: Intermittent IV Infusions01:24

Drug Accumulation During Multiple Dosing: Intermittent IV Infusions

Intermittent intravenous (IV) infusion is a method of drug administration where medications are delivered over short infusion periods followed by intervals of no drug delivery. This approach helps to prevent sustained high drug concentrations in the bloodstream, reducing the risk of adverse effects associated with prolonged exposure. Unlike continuous infusion, steady-state concentrations may not be achieved during a single dosing cycle but can be reached through repeated...
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...