Clinical Considerations for Vancomycin Use in Chronic Kidney Disease

Vancomycin remains vital for treating serious MRSA and other Gram- positive infections, but its use in chronic kidney disease (CKD) patients poses heightened challenges due to altered pharmacokinetics, risk of nephrotoxicity, and dosing complexity. Vancomycin induced nephrotoxicity is multifactorial, with risk factors including high trough concentrations, elevated area under the concentration- time curve (AUC), concurrent use of other nephrotoxic agents, prolonged therapy duration, and pre- existing renal impairment. Clinical manifestations range from mild serum creatinine elevation to acute kidney injury, potentially accelerating CKD progression. Traditional trough- based therapeutic drug monitoring (TDM) methods are increasingly seen as suboptimal.