Can vancomycin be used in patients with Acute Kidney Injury (AKI)?

From the Guidelines

Vancomycin Use in Acute Kidney Injury (AKI)

Vancomycin can be used in patients with Acute Kidney Injury (AKI), but it requires careful dose adjustment and monitoring due to the potential for drug accumulation and toxicity 1.

Dose Adjustment and Monitoring

The recommended dose adjustment for vancomycin in AKI is to administer 15-20 mg/kg every 24-48 hours, with trough levels monitored closely to avoid toxicity, aiming for a target trough concentration of 10-20 mg/L 1. The dose and frequency may need to be further adjusted based on the severity of AKI and individual patient factors, such as residual renal function and hemodialysis status.

Key Considerations

• Trough monitoring is recommended for patients with serious infections, renal dysfunction, or fluctuating volumes of distribution 1.
• Loading doses may be considered for serious suspected or documented MRSA infections, but clinical data are limited 1.
• Continuous infusion vancomycin regimens are not recommended due to lack of clear benefit over intermittent dosing 1.
• The pharmacodynamic parameter that best predicts efficacy of vancomycin is the ratio of the area under the curve (AUC) to the MIC (AUC/MIC), with a target AUC/MIC >400 1.

Clinical Guidance

In clinical practice, vancomycin use in AKI patients should be guided by careful consideration of the patient's renal function, volume status, and infection severity, with close monitoring of trough levels and adjustment of dosing as needed 1.

From the FDA Drug Label

Vancomycin should be used with caution in patients with renal insufficiency because the risk of toxicity is appreciably increased by high, prolonged blood concentrations. Systemic vancomycin exposure may result in acute kidney injury (AKI). The risk of AKI increases as systemic exposure/serum levels increase.

Vancomycin can be used in patients with Acute Kidney Injury (AKI), but with caution. The dosage of vancomycin must be adjusted for patients with renal dysfunction to minimize the risk of toxicity and worsening of AKI. Monitoring of renal function is essential in these patients. 2 2

From the Research

Vancomycin Use in Patients with Acute Kidney Injury (AKI)

• Vancomycin can be used in patients with AKI, but it requires careful monitoring of serum creatinine and vancomycin trough levels to minimize the risk of vancomycin-associated AKI 3, 4, 5, 6.
• The risk of AKI is higher in patients with higher vancomycin trough levels, particularly above 40 μg/mL 3, 4.
• Factors that increase the risk of AKI in patients receiving vancomycin include:
  • Higher serum vancomycin levels 4
  • Cumulative number of organ failures 4
  • Cirrhosis of the liver 4
  • Concurrent use of nephrotoxic agents 6
  • Daily dose of vancomycin >30 mg/kg 6
• Monitoring vancomycin trough levels daily until steady state is reached can help reduce the incidence of AKI in trauma patients 5.
• The use of area under the curve (AUC)-based dosing may reduce vancomycin exposure and decrease nephrotoxicity compared to trough-based dosing 7.
• The combination of vancomycin and piperacillin-tazobactam may increase the risk of AKI compared to vancomycin with meropenem or cefepime, even with AUC-based dosing 7.