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.
Wang et al. (Sat,) studied this question.