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

• Published in: PloS one Vol. 12; no. 3; p. e0173286
• Main Authors: Shields, Ryan K, Anand, Rohit, Clarke, Lloyd G, Paronish, Julie A, Weirich, Matthew, Perone, Hanna, Kieserman, Jake, Freedy, Henry, Andrzejewski, Christina, Bonilla, Hector
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.03.2017; Public Library of Science (PLoS)
• Subjects: Acinetobacter baumannii; Acute Kidney Injury - diagnosis; Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Adult; Aged; Aged, 80 and over; Analysis; Anti-Bacterial Agents - adverse effects; Antibiotics; Antimicrobial agents; Biology and Life Sciences; Care and treatment; Chemotherapy; Clinical medicine; Colistin; Colistin - adverse effects; Comorbidity; Constraining; Criteria; Critical care; Dosage and administration; Drug dosages; Health risks; Hospitals; Humans; Incidence; Infectious diseases; Injury prevention; Intravenous administration; Kidney diseases; Kidneys; Literature reviews; Liver; Liver diseases; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Pathogens; Patients; Pharmacokinetics; Practice guidelines (Medicine); Retrospective Studies; Risk analysis; Risk Factors; Severity of Illness Index; Therapy; Time Factors; Toxicity; Values; Vancomycin; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0173286

Acute 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. We 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. Among 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. Safe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.