Abstract: FR-PO0408
Clinical Phenotyping of Vancomycin-Associated Kidney Injury Using Large Electronic Health Data
Session Information
- AKI: Biomarkers, Diagnostics, and Risk Prediction
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Awdishu, Linda, University of California San Diego, La Jolla, California, United States
- Zhuang, Yonghua L., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Brasher, Maizy S., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Yousif, Zaid, University of California San Diego, La Jolla, California, United States
- Cole, Joanne B., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Joy, Melanie S., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Background
Vancomycin is associated with AKI in up to 5–40% of treated patients. Using a published DI-AKI clinical risk model, we modified and applied a phenotyping tool and adjudication dashboard within the University of Colorado Health Data Compass to characterize vancomycin-associated AKI.
Methods
Electronic health record study of adults (1/1/2013–7/1/2023). DIRECT definitions were modified to include Stage 1 AKI: reference SCr within 90 days pre-drug start; qualifying SCr (≥1.5x reference) within 14 days post-start. Cases required SCr at admission, drug start, AKI day, and discharge in valid temporal sequence. Variables included demographics, SCr, KDIGO staging, AKI risk factors, drug dosing/concentrations, dialysis, and recovery.
Results
Interim results from 1320 cases: median age 64 years (IQR 53–74), 48.4% female, median BMI 27.0. SCr rose 1.83 x reference; median reference SCr 0.80 mg/dL (IQR 0.60–1.02) and AKI-day SCr 1.57 mg/dL (IQR 1.14–2.29). KDIGO staging: 61.4% Stage 1, 25.4% Stage 2, 13.3% Stage 3. Comorbidities: hypertension 64.8%, diabetes 35.4%, heart failure 30.3%, CKD 24%. Admission AKI risk factors: hypoalbuminemia 88.3%, anemia 85.2%; in-hospital: contrast 40.8%, hypotension 29.6%, sepsis 14.2%. Median drug-to-AKI onset 2 days (IQR 1–5); 90.2% within 7 days. Median daily vancomycin dose 1,250 mg; median pre-AKI trough 17.6 mg/L (IQR 12.8–23.1), representing supratherapeutic pre-AKI troughs: 34.8% Stage 1, 36.8% Stage 2, 48.5% Stage 3. Among patients with >2 pre-AKI troughs, 73.7% showed a rising trend. Discharge outcomes: complete recovery 34.4%, partial 28.9%, no recovery 36.7%.
Conclusion
Vancomycin was temporally associated with significant rates of severe AKI early during therapy. Supratherapeutic concentrations preceded AKI in one-third of patients, and a rising trough trend warrants further investigation. A DI-AKI phenotyping model was successfully used to identify temporally consistent cases of vancomycin kidney injury.