Assessing the Epidemiology of Nephrotoxicity and the Role of Urinary Kidney Injury Molecule 1 as a Biomarker of Renal Function in Hematologic-Oncologic Patients Under Vancomycin Treatment in Shiraz, Iran

Background: Nephrotoxicity is a common adverse effect of vancomycin. However, some aspects of vancomycin nephrotoxicity have not been studied well in the Iranian population. Serum creatinine as a classic marker of renal function has several limitations in clinical practice. Objectives: To determine the incidence, time onset, and possible associated factors of vancomycin nephrotoxicity, and compare the patterns and the accuracy of urine kidney injury molecule 1 (KIM-1) with that of serum and urine creatinine during vancomycin treatment. Methods: A longitudinal study was performed during 9 months from August, 2015 to April, 2016 at three hematology-oncology wards of the Namazi Hospital in Shiraz, Iran. Patients > 18 years with no documented history of acute kidney injury or chronic kidney disease scheduled to receive vancomycin for at least 1 week were recruited. Required demographic and clinical data of patients were gathered. Serum, as well as urine creatinine and urine KIM-1, were determined at days 0, 3, 5, 7, 10, and 14 of vancomycin treatment. Results: Thirteen out of the 52 recruited patients (25%) developed nephrotoxicity, with a mean +/- standard deviation onset of 11.46 +/- 7.56 days. Furosemide co-administration (odds ratio = 0.126, 95% confidence interval = 0.023-0.694, P = 0.017) was significantly associated with vancomycin nephrotoxicity. Vancomycin nephrotoxicity resolved spontaneously in about two-fifths (38.46%) of the affected individuals. Mortality (P = 1) and duration of hospitalization (P = 0.175) were comparable between patients with and without nephrotoxicity. Urine KIM-1 increased during vancomycin treatment, but its mean values did not differ significantly within (P = 0.070) or between (P = 0.179) patients with and without nephrotoxicity. Urine KIM-1 accuracy in detecting vancomycin nephrotoxicity was significantly lower than that of serum creatinine at days 5, 7, and 10 of treatment. Conclusions: Vancomycin nephrotoxicity is common but usually reversible and has readily manageable adverse effect. Urine KIM-1 was not more accurate than serum or urine creatinine in detecting vancomycin nephrotoxicity in our study population.