Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria

Abstract

BackgroundAcute kidney injury (AKI) remains a treatment-limiting toxicity of colistin. Recently developed clinical practice guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) group have harmonized definitions of AKI, but have not been widely applied to patients receiving colistin.MethodsWe retrospectively defined AKI by KDIGO definitions among adult patients receiving intravenous colistin for ≥ 3 days. Risk factors for AKI within 48 hours and 7 days of initiating colistin were determined by multivariable logistic regression.ResultsAmong 249 patients treated with colistin, rates of AKI were 12% and 29% at 48 hours and 7 days, respectively. At 48 hours, patients in the intensive care unit were at increased risk for AKI. Within 7 days, colistin daily doses >5mg/kg, chronic liver disease, and concomitant vancomycin were independent predictors. Seven percent of patients required renal replacement therapy at a median of 5 days (range: 3–7) following colistin initiation.ConclusionSafe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

“…Unfortunately, there is no way of knowing (a priori) the rate of in vivo conversion for a particular batch. The impact of a loading dose on the risk of developing AKI is unclear . Considering the need for timely antibiotic administration, the therapeutic benefits of a loading dose may justify the potential risk of AKI associated with loading dose .…”

“…The impact of a loading dose on the risk of developing AKI is unclear. 52,54,64 Considering the need for timely antibiotic administration, the therapeutic benefits of a loading dose may justify the potential risk of AKI associated with loading dose. [65][66][67] The timing of the commencement of the maintenance dose should be based on the interval of the maintenance dose (e.g., if the patient is placed on colistin every 12 hours, the maintenance dose should start 12 hours later).…”

“…Recently, the largest RCT to date (AIDA study) 125 64 for clinical failure, and 46% vs 52%; p=0.40 for mortality). A total of 94% of patients in this study had either bacteremia or pneumonia with nearly an even split between the two.…”

Review of the international consensus guidelines for the optimal use of the polymyxins

“…К сожалению, нет возможности узнать реальную скорость in vivo конверсии препарата из конкретной партии. Влияние нагрузочной дозы на риск развития ОПП не определено [52,54,64]. Принимая во внимание необходимость своевременного введения антибиотика, терапевтическая польза от нагрузочной дозы может оправдать связанный с ней потенциальный риск ОПП [65][66][67].…”

Lesão renal aguda associada ao uso de polimixinas em pacientes críticos

“…3 Contudo, poucos estudos de ordem nacional, ou até mesmo internacional, avançaram em detalhar dados clínicos relacionados à essa toxicidade e fornecer informações mais precisas sobre a sua incidência em pacientes em situação de gravidade exacerbada. [4][5][6][7] As primeiras descrições de LRA datam da primeira metade do século XX, Desde então, em que pesem os avanços científicos principalmente nos recursos relativos à terapêutico, como o desenvolvimento tecnológico hospitalar, a evolução do arsenal de equipamentos e fármacos e a incorporação de melhor manejo clínico do paciente crítico com LRA, não se constatou redução na incidência, prevalência e mortalidade da LRA. 2,8 Estudos mais consistentes demonstram uma incidência hospitalar da LRA em torno de 5%, enquanto que nas UTIs chega a 40%, e conta com uma mortalidade superior a 50%.…”