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

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.
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.
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.
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.
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.