Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Abstract

BackgroundThe use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored.MethodsWe conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models.ResultsAmong 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively.ConclusionHydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation.Trial registrationClinicalTrials.gov, NCT03558646

Hydroxocobalamin-Induced Oxalate Nephropathy in a Patient With Smoke Inhalation

“…Although generally regarded safe, widespread use of hydroxocobalamin as a first-line agent for cyanide poisoning has been questioned by some. 1 A multicenter retrospective study from France found that hydroxocobalamin use in patients with smoke inhalation did not confer a survival advantage and was associated with increased risk of severe AKI and renal replacement therapy. 1 The etiology of AKI in these patients was unclear because renal biopsies were not performed.…”

“… 1 A multicenter retrospective study from France found that hydroxocobalamin use in patients with smoke inhalation did not confer a survival advantage and was associated with increased risk of severe AKI and renal replacement therapy. 1 The etiology of AKI in these patients was unclear because renal biopsies were not performed. In another study, hydroxocobalamin administration was associated with a significant risk of AKI and elevated urine oxalate levels in critically ill patients with burns, 2 of whom had oxalate nephropathy on renal biopsy.…”

“…Hydroxocobalamin, a natural form of vitamin B12 that chelates cyanide leading to formation of cyanocobalamin that is excreted by the kidneys, has been increasingly used as an antidote of cyanide poisoning. However, a retrospective French study found that hydroxocobalamin use for smoke inhalation was associated with increased risk of AKI and need for renal replacement therapy 3 . Moreover, another study reported high urine oxalate levels in patients treated with hydroxocobalamin 6 .…”

“…However, a retrospective French study found that hydroxocobalamin use for smoke inhalation was associated with an increased risk of acute kidney injury (AKI) and a need for renal replacement therapy. 1 Moreover, another study reported high urine oxalate levels in patients treated with hydroxocobalamin. 2 There is a paucity of reports regarding hydroxocobalamin-induced AKI from oxalate nephropathy.…”

No sex differences in the incidence, risk factors and clinical impact of acute kidney injury in critically ill patients with sepsis

“…Patients were categorized into the AKI group (KDIGO stage 3) if they received continuous renal replacement therapy (CRRT) within the first 7 days after ICU admission. Severe AKI was defined as KDIGO stage 2 or higher, otherwise it was defined as mild AKI ( 22 , 23 ). Secondary outcomes included the ICU and hospital mortality, which were defined as the occurrence of death during the ICU and hospital stay, respectively.…”