Optimising Therapeutic Target Attainment in Vancomycin Therapy for Patients Requiring Intermittent Haemodialysis
Abstract
Aims: To describe the pharmacokinetics of vancomycin in patients requiring intermittent haemodialysis (iHD) and provide guidance for optimised dosing for a three-times-weekly post-iHD regimen. Methods: A population pharmacokinetic study using retrospectively collected data was conducted in a remote Australian dialysis centre. Adult patients receiving post-iHD vancomycin therapy between 1st January 2017 and 31st July 2023 were screened. Inclusion criteria: ≥ 3 months of iHD, prescribed vancomycin, and recorded ≥ 1 vancomycin concentration. Pharmacokinetic analysis was performed using Monolix. The probability of pharmacokinetic/pharmacodynamic target attainment (PTA) for pre-iHD trough concentrations of 15-20 mg/L was simulated for various loading and maintenance doses. Results: A total of 302 vancomycin concentrations were available from 80 courses (58 patients, 45 were female) with a median age of 52 (IQR 45-61) years and weight of 75 (66.5-85.5) kg. A one-compartment model adequately described the data. Actual body weight was the only covariate retained in the final model. The estimated vancomycin clearance during non-iHD periods, during iHD periods, and volume of distribution were 0.54 L/h, 4.84 L/h, and 87.02 L, respectively. The simulations supported weight-based loading doses. The time to the next iHD session also significantly influenced the PTA of loading doses. Subjects with higher weight required lower weight-based doses, and vice versa. The PTA of maintenance doses was associated with the pre-iHD trough concentrations and the dosing intervals. Weight had a limited impact on the PTA of maintenance doses. Conclusion: A comprehensive vancomycin dosing nomogram was suggested for patients requiring iHD. Validation in future prospective studies is recommended.
Related
- Continuous infusion versus intermittent infusion of vancomycin: a systematic review and meta-analysis with a focus on nephrotoxicity, target attainment, and clinical outcomes
- Optimising hospital pharmacy inventory for high-value, intermittent-demand drugs using a machine-learning approach with LightGBM-Tweedie regression: a single-centre, retrospective study.
- Continuous vs. intermittent vancomycin infusion in critically ill patients: a systematic review and meta-analysis.
- Evaluation of Therapeutic Drug Monitoring for Vancomycin with Ratio of Area Under the Curve to Minimum Inhibitory Concentration at a Children’s and Women’s Tertiary Hospital
- Prospective evaluation of therapeutic target attainment with a beta-lactam dosing nomogram in critically ill adult patients
BibTeX
@article{tsai2026optimising,
title = {{Optimising Therapeutic Target Attainment in Vancomycin Therapy for Patients Requiring Intermittent Haemodialysis}},
author = {Danny Tsai and María Patricia Hernández-Mitre and Amy Legg and Jacqueline Martin and Cherian Sajiv and Sachin Kodgire and William Naughton and Sonja Janson and Jaquelyne Hughes and Xin Liu and Jason Roberts},
journal = {Nephrology},
year = {2026},
month = jun,
doi = {10.1111/nep.70239},
url = {https://hal.science/hal-05774848v1},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Optimising Therapeutic Target Attainment in Vancomycin Therapy for Patients Requiring Intermittent Haemodialysis
AU - Danny Tsai
AU - María Patricia Hernández-Mitre
AU - Amy Legg
AU - Jacqueline Martin
AU - Cherian Sajiv
AU - Sachin Kodgire
AU - William Naughton
AU - Sonja Janson
AU - Jaquelyne Hughes
AU - Xin Liu
AU - Jason Roberts
PY - 2026
DA - 2026/06/29
JO - Nephrology
DO - 10.1111/nep.70239
UR - https://hal.science/hal-05774848v1
AB - Aims: To describe the pharmacokinetics of vancomycin in patients requiring intermittent haemodialysis (iHD) and provide guidance for optimised dosing for a three-times-weekly post-iHD regimen. Methods: A population pharmacokinetic study using retrospectively collected data was conducted in a remote Australian dialysis centre. Adult patients receiving post-iHD vancomycin therapy between 1st January 2017 and 31st July 2023 were screened. Inclusion criteria: ≥ 3 months of iHD, prescribed vancomycin, and recorded ≥ 1 vancomycin concentration. Pharmacokinetic analysis was performed using Monolix. The probability of pharmacokinetic/pharmacodynamic target attainment (PTA) for pre-iHD trough concentrations of 15-20 mg/L was simulated for various loading and maintenance doses. Results: A total of 302 vancomycin concentrations were available from 80 courses (58 patients, 45 were female) with a median age of 52 (IQR 45-61) years and weight of 75 (66.5-85.5) kg. A one-compartment model adequately described the data. Actual body weight was the only covariate retained in the final model. The estimated vancomycin clearance during non-iHD periods, during iHD periods, and volume of distribution were 0.54 L/h, 4.84 L/h, and 87.02 L, respectively. The simulations supported weight-based loading doses. The time to the next iHD session also significantly influenced the PTA of loading doses. Subjects with higher weight required lower weight-based doses, and vice versa. The PTA of maintenance doses was associated with the pre-iHD trough concentrations and the dosing intervals. Weight had a limited impact on the PTA of maintenance doses. Conclusion: A comprehensive vancomycin dosing nomogram was suggested for patients requiring iHD. Validation in future prospective studies is recommended.
SN - 1320-5358
SN - 1440-1797
ER -