comparing effects of different doses of vancomycin on the biomarkers of acute kidney injury

Background: various urinary and serum proteins are being studied for detection of early stages of drug-induced nephrotoxicity like gamma-glutamyltransferase (ggt), glutathione-s-transferase (gst), n-acetyl-glucosaminidase (nag), neutrophil gelatinase-associated lipocalin (ngal), cystatin c (cys-c), and kidney injury molecule 1 (kim-1). as vancomycin nephrotoxicity is an important adverse reaction related to its high dose, its early diagnosis is vital. so in this study, effects of different vancomycin dosing on two renal biomarkers (cys-c and kim-1) of acute kidney injury and also serum creatinine were compared in patients with severe bacterial infections. methods: fifty-eight patients with severe infections requiring vancomycin therapy, randomly received vancomycin 1g/ twice daily (n=29) or 1g/ three times daily (n=29). serum levels of cys-c and kim-1 and urine level of cys-c were measured at baseline and every other and compared between two groups. results: serum level of cys-c demonstrated significant rise during vancomycin treatment in both groups. however, there was no significant difference between them. urine cys-c level neither changed significantly within nor between groups during vancomycin treatment. the same results were detected for serum kim-concentrations. conclusion: different doses of vancomycin showed comparable effects on the serum and urine biomarkers of acute kidney injury. so, it seems that increasing vancomycin dose to 15mg/kg three times a day may not significantly increase risk of nephrotoxicity.