Empirical aminoglycosides for peritonitis do not affect residual renal function

• Published in: American journal of kidney diseases Vol. 41; no. 3; p. 670
• Main Authors: Baker, Richard J, Senior, Heather, Clemenger, Michelle, Brown, Edwina A
• Format: Journal Article
• Language: English
• Published: United States 01.03.2003
• Subjects: Administration, Oral; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Cefazolin - administration & dosage; Cefazolin - therapeutic use; Ciprofloxacin - administration & dosage; Ciprofloxacin - therapeutic use; Creatinine - blood; Creatinine - metabolism; Creatinine - urine; Drug Administration Schedule; Female; Gentamicins - administration & dosage; Gentamicins - pharmacology; Gentamicins - therapeutic use; Humans; Infusions, Parenteral; Kidney - drug effects; Kidney - physiopathology; Male; Middle Aged; Peritoneal Dialysis - methods; Peritonitis - drug therapy; Peritonitis - microbiology; Practice Guidelines as Topic; Prospective Studies; Staphylococcal Infections - drug therapy; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Urea - blood; Urea - metabolism; Urea - urine
• ISSN: 1523-6838
• DOI: 10.1053/ajkd.2003.50129

Aminoglycosides have been proven to be an efficacious treatment for peritonitis in peritoneal dialysis patients for many years. Consequently, they have been recommended in previous guidelines for the empirical treatment of peritonitis. However, with the increasing emphasis on preserving residual renal function (RRF), there has been concern about the nephrotoxic potential of these compounds. The 2000 International Society of Peritoneal Dialysis (ISPD) guidelines recommended that aminoglycosides not be used in patients with RRF, and that ceftazidime be used instead. In 1997, in response to the 1996 ISPD guidelines, we changed our peritonitis regimen from vancomycin and ciprofloxacin to cefazolin and gentamicin. The aim of this study is to compare the change in renal function occurring after treatment of peritonitis with and without gentamicin. Using 6-monthly urine and dialysis clearance measurements, preperitonitis and postperitonitis RRF (mean of 24-hour urea and creatinine clearance) were determined for 70 peritonitis episodes treated with the aminoglycoside-based regimen (group A), 61 episodes treated without aminoglycosides (group B), and 74 control patients without peritonitis (group C). Group A had mean declines in estimated glomerular filtration rate and urine output of -0.08 +/- 0.50 mL/min/mon and -8.82 +/- 88.09 mL/24 h/mon compared with -0.17 +/- 0.27 mL/min/mon and -34.68 +/- 69.58 mL/24 h/mon in group B and -0.20 +/- 0.39 mL/min/mon and -14.61 +/- 77.33 mL/24 h/mon in group C, respectively. There were no significant differences between groups. In our patients, there was no evidence of an accelerated decline in RRF when using an empirical regimen containing aminoglycosides for peritonitis. Because there are few data to contradict this finding, we recommend the continued use of these drugs in peritonitis regimens, even in patients with significant RRF.