Renoprotective effects of melatonin against vancomycin- related acute kidney injury in hospitalized patients: A retrospective cohort study

Thomas S. Hong; Kelsey Briscese; Marshall Yuan; Kiran Deshpande; Lauren M. Aleksunes; Luigi Brunetti

doi:10.1128/AAC.00462-21

Renoprotective effects of melatonin against vancomycin- related acute kidney injury in hospitalized patients: A retrospective cohort study

Thomas S. Hong, Kelsey Briscese, Marshall Yuan, Kiran Deshpande, Lauren M. Aleksunes, Luigi Brunetti

Ernest Mario School of Pharmacy, Pharmacology & Toxicology

Rutgers, The State University

Research output: Contribution to journal › Article › peer-review

Abstract

Vancomycin is associated with nephrotoxicity, and the mechanism may in part be related to oxidative stress. In vitro and preclinical studies suggest that melatonin supplementation decreases oxidative stress. The objective of this study was to evaluate concomitant use of melatonin and vancomycin and the incidence of acute kidney injury (AKI). We performed a retrospective cohort study at a large community medical center. All consecutive patients admitted to the medical center between January 2016 and September 2020 who received vancomycin therapy alone or concomitantly with melatonin as part of ordinary care were considered for inclusion. The primary endpoint was the development of AKI, defined as an absolute increase in serum creatinine of$0.3mg/dl or a$50% increase in serum creatinine. All data were analyzed using descriptive statistics. A multivariable logistic regression was constructed to account for potential confounding variables. We identified a total of 303 adult patients meeting inclusion and exclusion criteria treated with vancomycin, 101 of which received melatonin concomitantly. Overall baseline characteristics were similar between the two groups except for the incidence of bacteremia/sepsis. After controlling for the vancomycin area under the curve, baseline creatinine clearance, and intensive care unit admission in a multivariable logistic regression analysis, melatonin use was associated with a 63% decrease in AKI (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14 to 0.96; P = 0.041). Melatonin use was associated with a significant reduction in vancomycin-related AKI. Although this was a retrospective study with a small sample size, given the magnitude of the difference seen, further large prospective studies are warranted.

Original language	American English
Article number	e00462-21
Journal	Antimicrobial agents and chemotherapy
Volume	65
Issue number	9
DOIs	https://doi.org/10.1128/AAC.00462-21
State	Published - Sep 2021

ASJC Scopus subject areas

Pharmacology
Pharmacology (medical)
Infectious Diseases

Keywords

Acute kidney injury
Antioxidant
Melatonin
Vancomycin

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10.1128/AAC.00462-21

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title = "Renoprotective effects of melatonin against vancomycin- related acute kidney injury in hospitalized patients: A retrospective cohort study",

abstract = "Vancomycin is associated with nephrotoxicity, and the mechanism may in part be related to oxidative stress. In vitro and preclinical studies suggest that melatonin supplementation decreases oxidative stress. The objective of this study was to evaluate concomitant use of melatonin and vancomycin and the incidence of acute kidney injury (AKI). We performed a retrospective cohort study at a large community medical center. All consecutive patients admitted to the medical center between January 2016 and September 2020 who received vancomycin therapy alone or concomitantly with melatonin as part of ordinary care were considered for inclusion. The primary endpoint was the development of AKI, defined as an absolute increase in serum creatinine of$0.3mg/dl or a$50% increase in serum creatinine. All data were analyzed using descriptive statistics. A multivariable logistic regression was constructed to account for potential confounding variables. We identified a total of 303 adult patients meeting inclusion and exclusion criteria treated with vancomycin, 101 of which received melatonin concomitantly. Overall baseline characteristics were similar between the two groups except for the incidence of bacteremia/sepsis. After controlling for the vancomycin area under the curve, baseline creatinine clearance, and intensive care unit admission in a multivariable logistic regression analysis, melatonin use was associated with a 63% decrease in AKI (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14 to 0.96; P = 0.041). Melatonin use was associated with a significant reduction in vancomycin-related AKI. Although this was a retrospective study with a small sample size, given the magnitude of the difference seen, further large prospective studies are warranted.",

keywords = "Acute kidney injury, Antioxidant, Melatonin, Vancomycin",

author = "Hong, {Thomas S.} and Kelsey Briscese and Marshall Yuan and Kiran Deshpande and Aleksunes, {Lauren M.} and Luigi Brunetti",

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AU - Hong, Thomas S.

AU - Briscese, Kelsey

AU - Yuan, Marshall

AU - Deshpande, Kiran

AU - Aleksunes, Lauren M.

AU - Brunetti, Luigi

PY - 2021/9

Y1 - 2021/9

N2 - Vancomycin is associated with nephrotoxicity, and the mechanism may in part be related to oxidative stress. In vitro and preclinical studies suggest that melatonin supplementation decreases oxidative stress. The objective of this study was to evaluate concomitant use of melatonin and vancomycin and the incidence of acute kidney injury (AKI). We performed a retrospective cohort study at a large community medical center. All consecutive patients admitted to the medical center between January 2016 and September 2020 who received vancomycin therapy alone or concomitantly with melatonin as part of ordinary care were considered for inclusion. The primary endpoint was the development of AKI, defined as an absolute increase in serum creatinine of$0.3mg/dl or a$50% increase in serum creatinine. All data were analyzed using descriptive statistics. A multivariable logistic regression was constructed to account for potential confounding variables. We identified a total of 303 adult patients meeting inclusion and exclusion criteria treated with vancomycin, 101 of which received melatonin concomitantly. Overall baseline characteristics were similar between the two groups except for the incidence of bacteremia/sepsis. After controlling for the vancomycin area under the curve, baseline creatinine clearance, and intensive care unit admission in a multivariable logistic regression analysis, melatonin use was associated with a 63% decrease in AKI (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.14 to 0.96; P = 0.041). Melatonin use was associated with a significant reduction in vancomycin-related AKI. Although this was a retrospective study with a small sample size, given the magnitude of the difference seen, further large prospective studies are warranted.

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Renoprotective effects of melatonin against vancomycin- related acute kidney injury in hospitalized patients: A retrospective cohort study

Abstract

ASJC Scopus subject areas

Keywords

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