Vancomycin dosing in chronic high-flux haemodialysis: a systematic review

Katrina Hui, Lydia Upjohn, Michelle Nalder, Kirsty Buising, Eugenie Pedagogos, Craig Nelson, Carl M.J. Kirkpatrick, David C.M. Kong

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The aim of this study was to systematically evaluate whether non-weight-based dosing (non-WBD) or weight-based dosing (WBD) of vancomycin leads to a higher proportion of patients achieving the pharmacokinetic/pharmacodynamic target. Studies from January 1985 to February 2017 were identified through Cochrane, MEDLINE and Embase databases. Those conducted in adults with end-stage renal disease receiving high-flux haemodialysis (HD) and intravenous vancomycin were included. The primary outcome was the proportion of patients with a pre-HD vancomycin concentration of 15–20 mg/L and/or an area under the concentration–time curve/minimum inhibitory concentration (AUC/MIC) ratio ≥400. Of the 3948 studies screened, 5 met the inclusion criteria. The proportion of patients with pre-HD concentrations between 15–20 mg/L were 35% (non-WBD) and 13% (WBD) post-loading dose. During maintenance dosing, the proportion of patients with pre-HD concentrations between 15–20 mg/L were 37% (non-WBD) and 50–67% (WBD). The proportion of pre-HD concentrations <15 mg/L was greater in the non-WBD group post-loading dose but was similar between the non-WBD and WBD group during maintenance dosing. One study reported that all patients had an AUC/MIC ≥ 400 for micro-organisms with an MIC ≤ 1 mg/L for weight-based maintenance dosing. The limited data suggest that WBD may be preferential as there was a smaller proportion of pre-HD concentrations falling below 15 mg/L. However, larger well-designed studies of higher quality are required to provide guidance for vancomycin dosing in the high-flux HD setting. Future research should focus on reporting AUC/MIC ratios and exploring clinical outcomes in this patient population.

Original languageEnglish
Pages (from-to)678-686
Number of pages9
JournalInternational Journal of Antimicrobial Agents
Issue number5
Publication statusPublished - 1 May 2018


  • End-stage renal disease
  • Glycopeptide
  • Haemodialysis
  • Vancomycin

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