ArticleInternational journal of clinical pharmacy2026
Exploring the effects of renal and cardiac functions on the pharmacokinetics of vancomycin in patients undergoing cardiac surgery: a population pharmacokinetic analysis.
Article in International journal of clinical pharmacy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionVancomycin is a glycopeptide antibiotic commonly prescribed to treat severe gram-positive infections; however, it has a narrow therapeutic range and potentially induces nephrotoxicity following overdosing. Most studies have revealed that renal function is the main factor influencing vancomycin clearance. However, the effects of cardiac insufficiency, which usually occurs early following surgery and can cause changes in the pharmacokinetics of various drugs, likely due to decreased cardiac output, on vancomycin metabolism are poorly understood.
aimThis study aimed to establish a vancomycin population pharmacokinetic model in patients undergoing cardiac surgery and simultaneously explore the effects of renal and cardiac functions on vancomycin pharmacokinetics.
methodThree hundred twenty patients treated with vancomycin were enrolled. The patients' vancomycin treatment history, specific vancomycin administration and sampling times, and laboratory test results were obtained from the electronic medical records. The data were analyzed using nonlinear mixed effects modeling. Model accuracy and robustness were evaluated with a goodness-of-fit plot, bootstrap resampling, and visual predictive checks. The vancomycin dosage strategy was simulated with a virtual patient using the pharmacokinetic parameters of the established model in different clinical scenarios.
resultsA one-compartment model was used to determine vancomycin pharmacokinetics. The estimated clearance (CL) and distribution volume (V) of vancomycin were 3.22 L/h and 88.3 L, respectively. The interindividual variabilities in CL and V were 26.0% and 48.9%, respectively, while the corresponding interoccasion variabilities were 8.9% and 13.6%. CL decreased as serum creatinine (Scr), cystatin C (CysC) and N-terminal pro-B-type natriuretic peptide levels increased. V decreased as the CysC levels and neutrophil counts increased but increased with age. The highest percentage of the within 24-h target area under the concentration curve (400-650 mg*h/L) for the virtual patient across the different clinical scenarios was 52.4-65.2%.
conclusionA vancomycin population pharmacokinetic model was established for cardiac surgery patients. Both renal and cardiac functions have confirmed effects on vancomycin pharmacokinetics.
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