---
title: "Vancomycin pharmacokinetics and dosing during CRRT in critically ill adults: scoping review"
id: "pubmed-42659642"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42659642"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42659642/"
doi: "10.1093/ajhp/zxag257"
published_at: "2026-08-27T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Vancomycin pharmacokinetics and dosing during CRRT in critically ill adults: scoping review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42659642
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42659642/)
- **DOI:** [10.1093/ajhp/zxag257](https://doi.org/10.1093%2Fajhp%2Fzxag257)
- **Published At:** 2026-08-27T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Purpose: The review examined how **continuous renal replacement therapy (CRRT)** and critical illness alter **vancomycin** pharmacokinetics (PK) and inform dosing strategies in critically ill adults. - Methods: A systematic scoping review followed PRISMA-ScR guidance. Searches (Ovid MEDLINE via PubMed, Cochrane Central, ClinicalTrials.gov) covered literature through April 2026. Inclusion: English-language studies of critically ill adults on CRRT assessing vancomycin PK using single- or multiple-dose population PK approaches. - Study yield: The search retrieved 114 studies; 24 met inclusion criteria and were analyzed. - Clearance (CL): Reported vancomycin total CL ranged from **1.5 to 4.8 L/h**. CRRT consistently influenced CL and accounted for at least **50% of total clearance** in included studies. - CRRT determinants: **CRRT modality and intensity** were key determinants of vancomycin clearance across studies. - Volume of distribution (Vd): Reported Vd values varied from **0.4 to 1.4 L/kg**, reflecting altered distribution in critical illness. - Variability: Population PK studies reported **high interindividual variability**, complicating standard dosing. - Dosing simulations: Model-based simulations supported **model-informed precision dosing**. Simulated loading doses ranged from **15–30 mg/kg**, and simulated maintenance doses varied from **5–20 mg/kg daily**. - Clinical implications: Because PK is highly variable in CRRT patients, individualized dosing, **therapeutic drug monitoring**, and model-informed approaches are emphasized. - Research gaps: The authors call for validation of personalized dosing strategies and studies linking PK/PD targets to clinical outcomes in this population. - Keywords and scope: Focus keywords include CRRT, ICU, critical care, pharmacokinetics, and vancomycin; the review is positioned to inform dosing practice and future trials.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Vancomycin pharmacokinetics and dosing in critically ill adult patients on continuous renal replacement therapy: A scoping review [Maha S Assadoon](https://pubmed.ncbi.nlm.nih.gov/?term=Assadoon+MS&cauthor_id=42659642)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#full-view-affiliation-1 "Department of Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia."), [Jeffrey C Pearson](https://pubmed.ncbi.nlm.nih.gov/?term=Pearson+JC&cauthor_id=42659642)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#full-view-affiliation-2 "Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA."), [Shayma H Alzaidi](https://pubmed.ncbi.nlm.nih.gov/?term=Alzaidi+SH&cauthor_id=42659642)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#full-view-affiliation-3 "Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, and Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia.") Affiliations Expand ### Affiliations * 1 Department of Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. * 2 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA. * 3 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, and Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia. * PMID: **42659642** * DOI: [ 10.1093/ajhp/zxag257 ](https://doi.org/10.1093/ajhp/zxag257) Item in Clipboard # Vancomycin pharmacokinetics and dosing in critically ill adult patients on continuous renal replacement therapy: A scoping review Maha S Assadoon et al. Am J Health Syst Pharm. 2026. Show details Display options Display options Format Abstract PubMed PMID Am J Health Syst Pharm Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Am+J+Health+Syst+Pharm%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Am+J+Health+Syst+Pharm%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42659642/) . 2026 Aug 27:zxag257. doi: 10.1093/ajhp/zxag257. Online ahead of print. ### Authors [Maha S Assadoon](https://pubmed.ncbi.nlm.nih.gov/?term=Assadoon+MS&cauthor_id=42659642)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#short-view-affiliation-1 "Department of Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia."), [Jeffrey C Pearson](https://pubmed.ncbi.nlm.nih.gov/?term=Pearson+JC&cauthor_id=42659642)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#short-view-affiliation-2 "Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA."), [Shayma H Alzaidi](https://pubmed.ncbi.nlm.nih.gov/?term=Alzaidi+SH&cauthor_id=42659642)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42659642/#short-view-affiliation-3 "Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, and Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia.") ### Affiliations * 1 Department of Pharmacy, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. * 2 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA. * 3 Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, and Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia. * PMID: **42659642** * DOI: [ 10.1093/ajhp/zxag257 ](https://doi.org/10.1093/ajhp/zxag257) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Purpose:** Acute kidney injury is common in critically ill patients, frequently requiring the use of continuous renal replacement therapy (CRRT). Both critical illness and CRRT significantly alter vancomycin pharmacokinetics, affecting dosing and therapeutic drug monitoring. This scoping review aimed to evaluate vancomycin pharmacokinetics and dosing in critically ill adults receiving CRRT. **Summary:** A systematic scoping review was conducted using PRISMA-ScR guidelines. Studies published through April 2026 were identified using a comprehensive search of Ovid MEDLINE via PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. Included studies were in English, involved critically ill adult patients on CRRT, and assessed vancomycin pharmacokinetics and dosing using single- or multiple-dose population pharmacokinetics. Authors screened studies using a standard form, and disagreements were resolved through consensus. The searches retrieved 114 studies, and 24 were included. Vancomycin total clearance (CL) ranged from 1.5 to 4.8 L/h and was consistently influenced by CRRT. CRRT accounted for at least 50% of total CL, with CRRT modality and intensity being key determinants. Vancomycin's volume of distribution varied within a range of 0.4 to 1.4 L/kg. Population pharmacokinetic studies showed high interindividual variability, and dose simulation studies supported model-informed precision dosing. Simulation studies reported loading and maintenance dose ranges of 15-30 mg/kg and 5-20 mg/kg daily, respectively. **Conclusion:** Vancomycin dosing in patients on CRRT is highly variable due to significant pharmacokinetic alterations, emphasizing the need for individualized dosing, therapeutic drug monitoring, and model-informed approaches. Future studies should focus on validating personalized dosing strategies and linking pharmacokinetic/pharmacodynamic targets with clinical outcomes in this population. **Keywords:** CRRT; ICU; critical care; pharmacokinetics; vancomycin. © American Society of Health-System Pharmacists 2026. All rights reserved. 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