Characteristics of risk factors for acute kidney injury among inpatients administered sulfamethoxazole/trimethoprim: a retrospective observational study

Abstract

Background Sulfamethoxazole/trimethoprim (SMX/TMP) potentially increases the serum creatinine levels, resulting in acute kidney injury (AKI). However, the clinical characteristics of the AKI associated with SMX/TMP and the risk factors for its development have not been fully characterized. Methods A retrospective cohort observational analysis was conducted on adult inpatients who started SMX/TMP treatment at the Tokyo Women’s Medical University, Yachiyo Medical Center, from April 2018 to March 2020. The primary outcome was AKI, defined as an increase in serum creatinine level of ≥ 50% from baseline. Multivariate logistic regression analysis was used to determine the risk factors for the AKI associated with SMX/TMP. Results Of the 281 patients, 32 (11.4%) developed AKI. The multivariate logistic regression analysis identified that body mass index (BMI) (odds ratio [OR] = 0.86, 95% confidence interval [95% CI] 0.76–0.97, p < 0.01), presence of hypertension (OR = 2.69, 95% CI 1.11–6.49, p = 0.02), SMX/TMP daily dose (OR = 1.16, 95% CI 1.03–1.30, p = 0.02), and concomitant loop diuretic use (OR = 2.91, 95% CI 1.08–7.78, p = 0.04) were the associated risk factors for AKI in patients who were administered SMX/TMP. Conclusions This study showed that low BMI, hypertension, high-dose SMX/TMP, and concomitant loop diuretic use increased the risk of AKI in patients administered SMX/TMP. Clinicians should consider monitoring the renal function in patients at a high risk of AKI.

Sulfamethoxazole-induced crystal nephropathy: characterization and prognosis in a case series

“…The cohort consisted mainly of elderly patients, frequently hypertensive, which aligns with findings from previous studies 12 , 13 , 34 . All patients in our study were immunocompromised, a condition leading to confirmed or suspected opportunistic infections that required SMX therapy.…”

“…In our study, the median time to onset of AKI after SMX introduction was 4 days (IQR 3.5–5 days), shorter than in Fraser’s study (6.5 days) and Shimizu’s study (8 days [IQR, 5–16 days]) 12 , 13 .…”

“…Previous studies have examined the population and risk factors for acute kidney injury on CMX 12 , 13 , 34 .…”

“…Fraser’s and Shimizu’s studies provided conflicting results regarding a dose-dependent relationship between SMX and AKI 12 , 13 . Fraser et al did not find a significant relationship whereas Shimizu et al identified a dose-dependent effect 12 .…”

“…In addition to its functional effect, it has been shown that CMX, and more specifically SMX, can cause acute kidney injury through either immunoallergic tubulointerstitial damages or acute tubular lesions due to drug precipitation 12 , 13 . These mechanisms have been described since the first use of sulfonamide antibiotics 14 – 18 .…”