A Scoping Review on Vancomycin Monitoring in Intermittent Hemodialysis: Current Evidence and Future Perspectives

Background: Despite the general recommendation of AUC 0–24h /MIC ratio of 400–600 mg·h/L for vancomycin (VAN) effectiveness, there is no strong evidence of this index for patients undergoing renal replacement therapy (RRT). The aim of this scoping review was to summarize the scientific literature to assess the current evidence on VAN monitoring in hospitalized patients receiving intermittent hemodialysis (HD), identify gaps in knowledge, and guide future research. Methods: A systematic search was performed using PubMed, Web of Science, Embase, LILACS, and the Cochrane Library databases based on keywords related to VAN, dialysis, and Therapeutic Drug Monitoring (TDM). References in the articles were also screened. The inclusion criteria were studies involving hospitalized adults undergoing intermittent HD, receiving intravenous VAN therapy, and with available TDM data. Results: Systematic searches retrieved 297 articles, of which 21 were selected along with 1 from the reference screening, for 22 included studies. Clinical outcome data are still insufficient to determine the best VAN TDM parameters for patients undergoing intermittent HD. Target attainment was suboptimal in most settings regardless of the TDM method. The intradialytic removal of VAN is highly variable because of the combination of the RRT modality, RRT parameters, and dialyzer characteristics, which are often poorly described. The exact influence of the RRT parameters on intermittent RRT settings remains unclear. Conclusions: The poor description of RRT, suboptimal VAN target attainment, and limited clinical outcome data in patients undergoing intermittent HD highlight the urgent need for further research. As VAN removal during RRT is influenced by a complex interplay of factors, improved dosing and monitoring strategies are required. In the future, model-informed precision dosing may play a significant role in optimizing VAN therapy in patients undergoing intermittent HD.