Risk Stratification for Vancomycin-Associated Acute Kidney Injury in Chinese Adult Inpatients: A Multicenter Retrospective Cohort Study.

Authors

Shu Chen, Ying Zhang, Xingyun Hou, Yuzhu Wang, Chengchun Zuo, Chengwei Huang, Xiaotong Xia, Chang Cao, Qianzhou Lv, Xiaoyu Li, Kunming Pan

Published in

Infection and drug resistance. Volume 19. Pages 618586. Epub Jul 22, 2026.

Abstract

Vancomycin-associated acute kidney injury (VA-AKI) remains a major safety concern during treatment of serious infections. We aimed to identify a clinically relevant vancomycin trough threshold associated with VA-AKI and to define factors associated with renal injury in Chinese adult inpatients.
We conducted a multicenter retrospective cohort study of 2230 Chinese adult inpatients treated with intravenous vancomycin between 2016 and 2025. VA-AKI was defined according to Kidney Disease: Improving Global Outcomes criteria. Receiver operating characteristic analysis was used to identify the trough threshold associated with VA-AKI, and multivariable logistic regression was performed to assess factors independently associated with VA-AKI.
VA-AKI occurred in 493/2230 patients (22.1%). The trough concentration most closely associated with VA-AKI was 15.9 mg/L (AUC 0.64). Compared with troughs <10 mg/L, concentrations of 10-20 mg/L and >20 mg/L were associated with progressively higher AKI risk. Factors independently associated with VA-AKI included contrast exposure, concomitant piperacillin-tazobactam or cephalosporin therapy, critical illness, treatment duration ≥14 days, cardiac dysfunction, and baseline renal impairment. VA-AKI was also associated with worse outcomes, including higher 60-day mortality (16% vs 4%) and greater dialysis requirement (6% vs 2%).
In this large multicenter cohort, VA-AKI occurred in approximately one in five Chinese adult inpatients receiving vancomycin. A vancomycin trough concentration of approximately 15.9 mg/L may serve as a practical threshold for early AKI risk stratification, particularly in clinical settings where AUC-guided monitoring is not routinely available. Closer renal surveillance may be warranted in patients with additional treatment-related or clinical risk factors.

PMID:
42504291
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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