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 (eAUCss) 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 eAUCss at the first measurement, model-informed precision dosing during the early phase of treatment may be warranted in this population.
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BibTeX
@article{fujita2026incidence,
title = {{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}},
author = {Kohei Fujita and Kazuhiro Yamamoto and Kotaro Itohara and Takashi Ogihara and Tomoyuki Sakaue and Atsushi Uda and Asami Morioka and Kazuhiko Yamashita and Tomohiro Omura and Ikuko Yano},
journal = {Biological and Pharmaceutical Bulletin},
year = {2026},
month = oct,
doi = {10.1248/bpb.b26-00361},
url = {https://www.jstage.jst.go.jp/article/bpb/49/10/49_b26-00361/_article},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - 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
AU - Kohei Fujita
AU - Kazuhiro Yamamoto
AU - Kotaro Itohara
AU - Takashi Ogihara
AU - Tomoyuki Sakaue
AU - Atsushi Uda
AU - Asami Morioka
AU - Kazuhiko Yamashita
AU - Tomohiro Omura
AU - Ikuko Yano
PY - 2026
DA - 2026/10/23
JO - Biological and Pharmaceutical Bulletin
DO - 10.1248/bpb.b26-00361
UR - https://www.jstage.jst.go.jp/article/bpb/49/10/49_b26-00361/_article
AB - 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 (eAUCss) 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 eAUCss at the first measurement, model-informed precision dosing during the early phase of treatment may be warranted in this population.
SN - 1347-5215
SN - 0918-6158
ER -