Vancomycin-associated acute kidney injury in patients with moderate CKD: a multicentre retrospective cohort study

Vancomycin, as a first-line treatment for methicillin-resistant staphylococcus aureus infections, is notably nephrotoxic. Research on vancomycin nephrotoxicity in patients with moderate chronic kidney disease (CKD) is still lacking. This study aims to investigate the incidence of vancomycin-associated acute kidney injury (VA-AKI) in patients with moderate CKD and to identify associated risk factors in this specific population.

This was a multicentre, retrospective, cohort study from China. Patients with estimated glomerular filtration rate (eGFR) ˂90 mL/(min·1.73 m²) who received vancomycin from January 2009 to December 2024 were included. For patients with moderate CKD and eGFR ˂60 mL/(min·1.73 m²), multivariate logistic regression analysis was used to identify the independent risk factors for VA-AKI and the prognosis of VA-AKI patients.

A total of 3844 patients were included, and 1194 patients had moderate CKD. The incidence of VA-AKI in patients with moderate CKD was 19.1% (228/1194). The risk of VA-AKI increased significantly with the progression of CKD stages (P = 0.003). Cardiac insufficiency (OR 1.816, 95% CI 1.320-2.500, P < 0.001), ICU admission (OR 2.018, 95% CI 1.449-2.810, P < 0.001), and duration of vancomycin therapy (OR 1.482, 95% CI 1.071-2.051, P = 0.018) were significantly and independently associated with VA-AKI in patients with moderate CKD.

The incidence of VA-AKI in patients with moderate CKD is slightly higher than that in mixed populations (general, unselected hospitalized cohorts). This study indicates that the risk of VA-AKI increases with the severity of CKD staging. Heart failure, ICU admission, and duration of vancomycin therapy may result in a higher risk of VA-AKI occurrence.