Nephrotoxicity and Efficacy Assessment of Polymyxin B Use in Renal Transplant Patients

Abstract

Purpose This study investigates the nephrotoxicity and efficacy assessment of polymyxin B (PMB) use in renal transplant patients. Patients and Methods This retrospective study included adult (>18 years of age) renal transplant patients who received PMB intravenous drip for more than 72 hours. Efficacy assessment of PMB included clinical treatment efficacy, microbiological efficacy at the end of PMB treatment, and in-hospital all-cause mortality. Nephrotoxicity of PMB was evaluated for further group comparison. Results We enrolled 235 renal transplant patients in our study. After PMB treatment, 45 patients occurred PMB-nephrotoxicity, and the nephrotoxicity rate was 19.15%. Among them, 44 patients were RIFLE R stage, and one patient was RIFLE I stage. The dose of PMB used in patients was 40.0 (40.0–50.0) mg q12h with a loading dose of 41.8±9.8 mg. Multivariate logistic regression analysis showed that ICU admission, vasoactive agents, aminoglycosides, creatinine clearance rate before PMB use, and mean total hospital stay were independent risk factors of PMB-nephrotoxicity in kidney transplant patients. The clinical effective rate was 97.9%, and the microbiological clean rate was 66.7%. Conclusion Our study demonstrated that PMB low dose regimens might achieve good efficacy and less nephrotoxicity in renal transplant patients. We should evaluate the severity of the infection and renal function of patients, avoid the combined use of other nephrotoxic drugs, and minimize the course of use to reduce the occurrence of PMB-nephrotoxicity.

Population pharmacokinetic analysis, renal safety, and dosing optimization of polymyxin B in lung transplant recipients with pneumonia: A prospective study

“…29 (85.29%) patients were considered of clinical cure or improved. The clinical efficacy of polymyxin B in the current study was similar to the efficacy of polymyxin B in other transplant patients reported previously ( Mostardeiro et al, 2013 ; Wen et al, 2022 ). However, a relatively lower nephrotoxicity rate of polymyxin B (14.71%) was observed in our study compared to those reported in renal transplant patients, since kidney transplant patients are prone to renal dysfunction ( Mostardeiro et al, 2013 ; Wen et al, 2022 ).…”

“…The clinical efficacy of polymyxin B in the current study was similar to the efficacy of polymyxin B in other transplant patients reported previously ( Mostardeiro et al, 2013 ; Wen et al, 2022 ). However, a relatively lower nephrotoxicity rate of polymyxin B (14.71%) was observed in our study compared to those reported in renal transplant patients, since kidney transplant patients are prone to renal dysfunction ( Mostardeiro et al, 2013 ; Wen et al, 2022 ). However, a recent study performed by Li et al (2021) in renal transplant patients showed an extremely low incidence of AKI, as they used a relatively lower maintenance dose of 40 mg q12h.…”