Is trimethoprim/sulfamethoxazole-associated increase in serum creatinine a pseudo-elevation or true nephrotoxicity?. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Urakami, Toshiharu; Hamada, Yohei; Oka, Yusuke; Kannae, Mikinori; Okinaka, Tomohide; Sanada, Ayaka; Shimanoe, Chisato; Aoki, Yosuke
• Is Part Of: Journal of infection and chemotherapy. Volume 27:Issue 8(2021)
• Page Start: 1193
• Page End: 1197
• Publication Date: 2021-08
• Subjects: Trimethoprim/sulfamethoxazole -- Pseudo-elevation -- Nephrotoxicity -- Cystatin C; ACE-I angiotensin-converting enzyme inhibitor -- ARB angiotensin receptor blocker -- BMI body mass index -- GFR glomerular filtration rate -- GFRpost-cr creatinine-estimated GFR after trimethoprim/sulfamethoxazole administration -- GFRpost-cysC cystatin C-estimated GFR after trimethoprim/sulfamethoxazole administration -- GFRpre-cr creatinine-estimated GFR before trimethoprim/sulfamethoxazole administration -- GFRpre-cysC cystatin C- estimated GFR before trimethoprim/sulfamethoxazole administration -- IQR interquartile range -- NSAIDs non-steroidal anti-inflammatory drugs -- SMX sulfamethoxazole -- TMP trimethoprim; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2021.03.015
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Introduction: The aim of this study was to determine the rates of trimethoprim/sulfamethoxazole (TMP/SMX)-associated pseudo-elevation and true nephrotoxicity by comparison of creatinine-estimated and cystatin C-estimated GFRs (glomerular filtration rates) before and after TMP/SMX administrations. Methods: Patients in whom serum creatinine and cystatin C were simultaneously measured are the cohort of this study. A decreasing of creatinine-estimated GFR posterior to TMP/SMX by ≥ 20% and a decreasing of cystatine C-estimated GFR posterior to TMP/SMX by ≥ 20% were defined as true nephrotoxicity. A decreasing of creatinine-estimated GFR posterior to TMP/SMX by ≥ 20% and a decreasing of cystatine C-estimated GFR posterior to TMP/SMX by < 20% were defined as pseudo-elevation. Results: A total of 66 patients were enrolled. Within the 19 patients in whom serum creatinine and cystatin C were measured simultaneously both before and after TMP/SMX administrations, 10 patients (52.6%) had nephrotoxicity. Fewer random error and systematic bias between creatinine- and cystatine C-estimated GFR were observed after TMP/SMX than before TMP/SMX by Bland-Altman analysis. Conclusions: Using cystatin C, we reveled TMP/SMX-associated nephrotoxicity is not uncommon. We should equally pay attention to TMP/SMX-associated nephrotoxicity and pseudo-elevation. In spite of pseudo-elevation, creatinine-estimated GFR after receiving TMP/SMX is ironically reliable as surrogate maker for renal clearance.