Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis

Abstract

BACKGROUND Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality. AIM To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit (ICU) patients. METHODS PubMed, EMBASE, the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30, 2022. The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver. 12.1. Additionally, subgroup analyses and meta-regression were conducted to assess heterogeneity. RESULTS A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis. The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%. The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B (PMB)-induced nephrotoxicity. The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval, nephrotoxicity criteria, age, publication year, study quality and sample size, which were confirmed in the univariable meta-regression analysis. Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses. Furthermore, older age, the presence of sepsis or septic shock, hypoalbuminemia, and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity, while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity. CONCLUSION Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high. It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.

Clinical Efficacy and Safety of Colistin Sulfate in the Treatment of Carbapenem-Resistant Organism Infections in Patients with Hematological Diseases

“…Studies have shown that nephrotoxicity is dose limiting for polymyxins [ 19 , 41 , 42 ]. Two recent meta-analyses showed that the overall incidences of CMS- and PMB-induced nephrotoxicity were 34.8% and 45%, respectively [ 43 , 44 ]. Compared with those of CMS and polymyxin B, the event of renal impairment associated with colistin sulfate was considerably lower (up to 9.2%) [ 21 , 45 ].…”

Crude Mortality Associated With the Empirical Use of Polymyxins in Septic Patients in a Setting of High Prevalence of Carbapenem-Resistant Gram-negative Bacteria: Retrospective Analysis of a Cohort

“…Polymyxins are toxic drugs and are associated with many adverse events; renal toxicity is one of the most important. A recent meta-analysis showed that the prevalence of nephrotoxicity during polymyxin treatment in the ICU was 34.8%, similar to the non-ICU setting [ 29 ]. We should consider the balance between the potential benefit of liberally using empirical polymyxins and the risk of severe adverse events.…”

Development and validation of a prognostic nomogram to predict 30-day all-cause mortality in patients with CRO infection treated with colistin sulfate

“…The observed 28-day or in-hospital all-cause mortality rates also varied from studies for colistin sulfate, with a wide range of 9.3%–44% ( Hao et al, 2022 ; Jin et al, 2022 ; Lu et al, 2022 ; Peng et al, 2023 ). However, compared with colistimethate sodium or polymyxin B sulfate, colistin sulfate is associated with less nephrotoxicity, as demonstrated in recent real-world studies ( Hao et al, 2022 ; Jin et al, 2022 ; Lu et al, 2022 ; Wang et al, 2022 ; Peng et al, 2023 ). These findings suggest the necessity for further evaluation of the mortality risk factors related to CRO infections during colistin sulfate treatment.…”