Incidence of Acute Kidney Injury in the Model-Based AUC-Guided Dosing of Vancomycin Compared with Conventional Trough-Guided Dosing in Patients with Severely Impaired Renal Function

Abstract

Vancomycin dosing guided by the area under the time–concentration curve (AUC) has been reported to lower the incidence of acute kidney injury (AKI) compared with dosing guided by trough concentration in patients with normal renal function and mild-to-moderate renal impairment. In this retrospective study, we aimed to evaluate the safety of model-based AUC-guided dosing compared with conventional trough-guided dosing in patients with severe renal impairment. Patients with an estimated glomerular filtration rate <30 mL/min/1.73m² who have been receiving vancomycin for at least 4 d were included, whereas patients undergoing dialysis were excluded. A total of 44 and 20 patients were included in the trough- and AUC-guided groups, respectively. AKI within 14 d occurred in 10 patients (22.7%) in the trough-guided group and in 2 patients (10.0%) in the AUC-guided group; no significant difference was observed in the cumulative incidence of AKI between the groups (p = 0.29). In univariate Cox proportional hazards regression analysis, the observed trough concentration and estimated steady-state AUC (eAUC_ss) at the first measurement were significantly associated with the cumulative incidence of AKI. In conclusion, no statistically significant difference was observed between model-based AUC-guided dosing and conventional trough-guided dosing in terms of safety, although the results should be interpreted with caution because of the small sample size. Considering that AKI incidence within 14 d was associated with the vancomycin trough concentration and eAUC_ss at the first measurement, model-informed precision dosing during the early phase of treatment may be warranted in this population.