Vancomycin, a glycopeptide antibiotic, has remained a popular antimicrobial agent throughout the past five decades, and is often included in empiric antibiotic regimens. With gram-positive coverage, it has found a niche in the treatment of methicillin-resistant Staphylococcus aureus. Although vancomycin has been in existence for many years, questions remain regarding its use. New technologies and practice pattern changes have occurred over the years that altered vancomycin dosing in hemodialysis (HD) patients. Examples of these changes include increased resistance of many organisms, development of high flux HD filters, and reprocessing practices. This review provides a summary of the several concerns that exist in the dosing of vancomycin in HD patients today, and provides a summary table of intradialytic dosing regimens.