Incidence and Risk Factors of Acute Kidney Failure in Patients Receiving Colistin in a Provincial Hospital

Piyatida Taejaroenkul; Sunisa Khamlek; Nitta Khienprasit; Aroonrut Lucksiri

doi:10.14456/nujst.2019.8

Authors

Piyatida Taejaroenkul Graduate student of Chiang Mai University, Amphoe Muang, Chiang Mai, Thailand 50202
Sunisa Khamlek Faculty of Pharmacy Phayao University, Amphoe Muang, Phayao, Thailand 56000
Nitta Khienprasit Department of infectious disease, Bangkok Hospital, Amphoe Muang, Chiang Mai, Thailand 50000
Aroonrut Lucksiri Faculty of Pharmacy Chiang Mai University, Amphoe Muang, Chiang Mai, Thailand 50202

DOI:

https://doi.org/10.14456/nujst.2019.8

Keywords:

colistin, acute kidney failure, nephrotoxicity

Abstract

The objectives of this study were to determine incidence and risk factors associated with acute kidney failure in patients receiving colistin. This study was a retrospective cohort study from medical records of patients who received colistin at Nakornping Hospital, Chiang Mai, during January 1, 2011 to December 31, 2013. The statistical analyses include descriptive statistic, multivariate analysis and Kaplan-Meier method. The results showed that most patients were male (65.7%) with the median age of 67 years (range of 19-95 years). The median value of serum creatinine was 0.9 mg/dl (range of 0.3-6.7 mg/dl). Approximately half of the patients (50.7%) received loading doses and 46% (171 pateints) of them received colistin more than 5 mg/kg/day. The study observed 262 patients (70.8%) developed nephrotoxicity with the median onset of 7 days (95% CI 6-7). Among the patients who experienced nephrotoxicity, the severity of acute kidney failure of 101 cases (27.3 %) were classified as “failure”, 95 cases (25.7%) were classified as “risk” and 66 cases (17.8%) were classified as “injury”. Multivariable analysis revealed the risk factors associated with acute kidney failure as follows: (1) age older than 70 years old (OR = 4.0; p = 0.001), (2) having diseases that may decrease renal blood flow (OR. = 2.1; p = 0.008), (3) receiving colistin more than 5 mg/kg/day (OR = 2.1; p = 0.007), and (4) co-administration of nephrotoxic drugs or drug affecting the glomuerulus filtration rate (OR = 1.8; p = 0.023). However, the patients with baseline serum creatinine more than 1.2 mg/dl appeared to have lower risk of acute kidney failure than the patients with the values of serum creatinine less than or equal to 1.2 mg/dl. This study showed high incidence (70.8%) of acute kidney failure in patients receiving colistin. Thus, renal functions should be closely monitored, especially in elderly patients, patients with diseases that may decrease renal blood flow, patients concurrently received nephrotoxic drugs or drug affecting the glomerular filtration rate. Besides, the patients’ weight should be used to determine the appropriate colistin dose and adjusting dose should be performed based on the pateints’ renal functions or avoiding the use of colistin doses greater than 5 mg/kg/day.

References

Barlett, J. G., Auwaerter, P. G., & Pham, P. A. ( 2012). Johns Hopkins ABX Guide: Diagnosis and Treatment of Infectious Diseases 2012 (3rd ed.). Johns Hopkins Medicine University, Baltimore, Maryland, United States.

Cramer, B. C., Parfrey, P. S., Hutchinson, T. A., Baran, D., Melanson, D. M., Ethier, R. E., & Seely, J. F. (1985). Renal function following infusion of radiologic contrast material: a prospective controlled study. Archives of internal medicine, 145(1), 87-89.

DeRyke, C. A., Crawford, A. J., Uddin, N., & Wallace, M. R. (2010). Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrobial Agents and Chemotherapy, 54(10), 4503-4505.

Dipiro, J. T., Talbert, R. L., Yee, G., Matzke, G. R., Wells, B. G., & Posey, L. M. (2005). Pharmacotherapy: A pathophysiologic approach (3rd ed.). New York: The McGraw-Hill Companies.

Doshi, N. M., Mount, K. L., & Murphy, C. V. (2011). Nephrotoxicity associated with intravenous colistin in critically ill patients. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 31(12), 1257-1264.

Falagas, M. E., & Kasiakou, S. K. (2006). Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Critical care, 10(1), 1.

Garcia‐Tsao, G., Parikh, C. R., & Viola, A. (2008). Acute kidney injury in cirrhosis. Hepatology, 48(6), 2064-2077.

Gauthier, T. P., Wolowich, W. R., Reddy, A., Cano, E., Abbo, L., & Smith, L. B. (2012). Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients. Antimicrobial Agents and Chemotherapy, 56(5), 2392-2396.

Handin, R., Braunwald, E., Fauci, A., Kasper, D., Hauser, S., Longo, D., & Jameson, J. (2005). Acute renal failure. New York: McGraw-Hill.

Hartzell, J. D., Neff, R., Ake, J., Howard, R., Olson, S., Paolino, K., . . . Wortmann, G. (2009). Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center. Clinical infectious diseases, 48(12), 1724-1728.

Hock, R., & Anderson, R. J. (1995). Prevention of drug-induced nephrotoxicity in the intensive care unit. Journal of Critical Care, 10(1), 33-43.

Kim, J., Lee, K.-H., Yoo, S., & Pai, H. (2009). Clinical characteristics and risk factors of colistin-induced nephrotoxicity. International Journal of Antimicrobial Agents, 34(5), 434-438.

Ko, H., Jeon, M., Choo, E., Lee, E., Kim, T., Jun, J.-B., & Gil, H.-W. (2010). Early acute kidney injury is a risk factor that predicts mortality in patients treated with colistin. Nephron Clinical Practice, 117(3), c284-c288.

Koomanachai, P., Tiengrim, S., Kiratisin, P., & Thamlikitkul, V. (2007). Efficacy and safety of colistin (colistimethate sodium) for therapy of infections caused by multidrug-resistant< i> Pseudomonas aeruginosa and< i> Acinetobacter baumannii in Siriraj Hospital, Bangkok, Thailand. International Journal of Infectious Diseases, 11(5), 402-406.

Kwon, J.-A., Lee, J. E., Huh, W., Peck, K. R., Kim, Y.-G., Kim, D. J., & Oh, H. Y. (2010). Predictors of acute kidney injury associated with intravenous colistin treatment. International Journal of Antimicrobial Agents, 35(5), 473-477.

Lopes, J. A., & Jorge, S. (2013). The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clinical Kidney Journal, 6(1), 8-14.

Mingeot-Leclercq, M.-P., & Tulkens, P. M. (1999). Aminoglycosides: nephrotoxicity. Antimicrobial Agents and Chemotherapy, 43(5), 1003-1012.

Nash, K., Hafeez, A., & Hou, S. (2002). Hospital-acquired renal insufficiency. American Journal of Kidney Diseases, 39(5), 930-936.

Plataki, M., Kashani, K., Cabello-Garza, J., Maldonado, F., Kashyap, R., Kor, D. J., . . . Cartin-Ceba, R. (2011). Predictors of acute kidney injury in septic shock patients: an observational cohort study. Clinical Journal of the American Society of Nephrology, 6(7), 1744-1751.

Pogue, J. M., Lee, J., Marchaim, D., Yee, V., Zhao, J. J., Chopra, T., . . . Kaye, K. S. (2011). Incidence of and risk factors for colistin-associated nephrotoxicity in a large academic health system. Clinical infectious diseases, 53(9), 879-884.

Pruchnicki, M. C., & Dasta, J. F. (2002). Acute renal failure in hospitalized patients: part I. Annals of Pharmacotherapy, 36(7-8), 1261-1267.

Rattanaumpawan, P., Ungprasert, P., & Thamlikitkul, V. (2011). Risk factors for colistin-associated nephrotoxicity. Journal of Infection, 62(2), 187-190.

Storm, D. R., Rosenthal, K. S., & Swanson, P. E. (1977). Polymyxin and related peptide antibiotics. Annual review of biochemistry, 46(1), 723-763.

Thamlikitkul, V. (2008). Colistin: Antibiotic therapy for gram-negative bacteria. Siriraj Medical Bulletin, 1(3), 152-158.

Vicari, G., Bauer, S. R., Neuner, E. A., & Lam, S. W. (2013). Association between colistin dose and microbiologic outcomes in patients with multidrug-resistant gram-negative bacteremia. Clinical infectious diseases, 56(3), 398-404.