Colistin nephrotoxicity increases with age. (October 2014)

• Record Type: Journal Article
• Authors: Balkan, Ilker Inanc; Dogan, Mustafa; Durdu, Bulent; Batirel, Ayse; Hakyemez, Ismail N.; Cetin, Birsen; Karabay, Oguz; Gonen, Ibak; Ozkan, Ahmet Selim; Uzun, Sami; Demirkol, Muhammed Emin; Akbas, Sedat; Kacmaz, Asiye Bahar; Aras, Sukru; Mert, Ali; Tabak, Fehmi
• Is Part Of: Scandinavian journal of infectious diseases. Volume 46:Number 10(2014:Oct.)
• Page Start: 678
• Page End: 685
• Publication Date: 2014-10
• Subjects: Communicable diseases -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.3109/00365548.2014.926021
• Languages: English
• ISSNs: 0036-5548

Abstract

<abstract> <title>Abstract</title> <p> <italic>Background:</italic> Colistin (COL) has become the backbone of the treatment of infections due to extensively drug-resistant (XDR) Gram-negative bacteria. The most common restriction to its use is acute kidney injury (AKI). <italic>Methods:</italic> We conducted a retrospective cohort study to evaluate risk factors for new-onset AKI in patients receiving COL. The cohort consisted of 198 adults admitted to 9 referral hospitals between January 2010 and October 2012 and treated with intravenous COL for ≥ 72 h. Patients with no pre-existing kidney dysfunction were compared in terms of risk factors and outcomes of AKI graded according to the RIFLE criteria. Logistic regression analysis was used to identify associated risk factors. <italic>Results:</italic> A total of 198 patients met the inclusion criteria, of whom 167 had no pre-existing kidney dysfunction; the mean patient age was 58.77 (± 18.98) y. Bloodstream infections (34.8%) and ventilator-associated pneumonia (32.3%) were the 2 most common indications for COL use. New-onset AKI developed in 46.1% of the patients, graded as risk (10%), injury (15%), and failure (21%). Patients with high Charlson co-morbidity index (CCI) scores (<italic>p</italic> = 0.001) and comparatively low initial glomerular filtration rate (GFR) estimations (<italic>p</italic> < 0.001) were more likely to develop AKI, but older age (<italic>p</italic> = 0.001; odds ratio 5.199, 95% confidence interval 2.684–10.072) was the major predictor in the multivariate analysis. In-hospital recovery from AKI occurred in 58.1%, within a median of 7 days. <italic>Conclusions:</italic> COL-induced nephrotoxicity occurred significantly more often in patients older than 60 y of age and was related to low initial GFR estimations and high CCI scores, which were basically determined by age.</p> </abstract>