Abstract

Vancomycin-induced acute kidney injury (AKI) is a well-documented adverse effect, particularly in high-risk populations such as patients with type 2 diabetes mellitus (T2DM) and augmented renal clearance (ARC). However, optimal dosing strategies for diabetic patients with ARC remain unclear, increasing the risk of nephrotoxicity. A 36-year-old male with newly diagnosed T2DM (HbA1c 11.6%) and ARC (baseline estimation of glomerular filtration rate (eGFR) 270 – 301 mL/min/1.73m²) developed AKI following high-dose vancomycin therapy (1.5g q8h) for a methicillin-resistant Staphylococcus aureus (MRSA) abscess. Despite initially subtherapeutic trough levels (8.83 μg/mL), the patient experienced AKI (serum creatinine: 195 μmol/L; eGFR 36.1 mL/min) coinciding with a toxic trough level (75.84 μg/mL) on day 7 after vancomycin administration. AKI resolved after vancomycin discontinuation and aggressive hydration. Diabetic patients with ARC are at increased risk of vancomycin-induced AKI, even with subtherapeutic troughs. Close renal function monitoring, individualized dosing, and consideration of AUC-based protocols or alternative antibiotics (e.g., linezolid) are essential for mitigating nephrotoxicity. Further pharmacokinetic studies in this population are warranted to optimize therapeutic outcomes.

Author Details

Authors

• Liang-Fen Wang¹
• Ju Zhou²
• Rong Chen¹

Departments

• ¹ Department of Pharmacy, and
• ² Department of Orthopedic,
• ³ 
• ⁶ 
• ³  Hospital, Chengdu, China

Address

Liang-Fen Wang, PhD
Department of Pharmacy
363 Hospital, No. 550, East Campus Road,
Pidu District, Chengdu, China
Email: [email protected]

Citation