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Risk Stratification for Vancomycin-Associated Acute Kidney Injury in Chinese Adult Inpatients: A Multicenter
Shu Chen1, Ying Zhang2, Xingyun Hou3
1Department of Pharmacy, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
Infection and Drug Resistance
|July 27, 2026
Summary
Vancomycin-associated acute kidney injury (VA-AKI) affects about 22% of Chinese inpatients. A vancomycin trough of 15.9 mg/L is linked to increased risk, highlighting the need for careful monitoring.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Vancomycin-associated acute kidney injury (VA-AKI) is a significant clinical concern.
- Identifying reliable vancomycin trough thresholds is crucial for patient safety.
- Understanding risk factors for VA-AKI in diverse populations is essential.
Purpose of the Study:
- To determine a clinically relevant vancomycin trough concentration threshold associated with VA-AKI.
- To identify factors contributing to renal injury in Chinese adult inpatients receiving vancomycin.
- To assess the impact of VA-AKI on patient outcomes.
Main Methods:
- Multicenter retrospective cohort study of 2230 Chinese adult inpatients treated with intravenous vancomycin.
- VA-AKI defined using Kidney Disease: Improving Global Outcomes (KDIGO) criteria.
- Receiver operating characteristic (ROC) analysis and multivariable logistic regression used to identify thresholds and risk factors.
Main Results:
- VA-AKI occurred in 22.1% of patients.
- The vancomycin trough concentration most associated with VA-AKI was 15.9 mg/L.
- Risk factors included contrast exposure, specific antibiotic co-therapy, critical illness, prolonged treatment, cardiac dysfunction, and baseline renal impairment.
Conclusions:
- A vancomycin trough of approximately 15.9 mg/L may serve as a practical threshold for AKI risk stratification.
- Enhanced renal surveillance is recommended for patients with additional risk factors.
- VA-AKI is associated with increased mortality and dialysis requirements.
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