Nephrotoxicity Associated with Intravenous Colistin in Critically Ill Patients

Doshi, Neha; Mount, Kari; Murphy, Claire V.

doi:10.1592/phco.31.12.1257

Cited by 70 publications

(79 citation statements)

References 17 publications

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“…Numerous studies have evaluated the prevalence of colistinassociated nephrotoxicity, but the rates vary widely in the literature, ranging anywhere from 10% to 48% (3)(4)(5)(6). The reasons for such wide variability are multifactorial.…”

mentioning

confidence: 99%

Validation of a Model To Predict the Risk of Nephrotoxicity in Patients Receiving Colistin

Phe

Johnson

Palmer

et al. 2014

Antimicrob Agents Chemother

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b Despite concerns about its nephrotoxicity, colistin often remains the only effective agent for treating multidrug-resistant Gramnegative infections. Published studies have reported a wide range of nephrotoxicity risk factors. To assess the clinical utility of various models, we compared their performances for predicting the risk of nephrotoxicity. We identified a model demonstrating reasonable overall risk assessment, with an observed/expected ratio of 1.29 (95% confidence interval [CI], 0.68 to 1.90) and a positive predictive value of 87.5% for identifying patients at high risk of developing nephrotoxicity. Multidrug-resistant (MDR) infections caused by Gram-negative bacteria are increasing worldwide and are associated with significant morbidity and mortality (1, 2). With a lack of new antibiotics in development, there has been a resurgence in the use of colistin, as it still demonstrates activity against many of these MDR organisms. However, colistin is associated with significant nephrotoxicity, which limits its widespread use.Numerous studies have evaluated the prevalence of colistinassociated nephrotoxicity, but the rates vary widely in the literature, ranging anywhere from 10% to 48% (3-6). The reasons for such wide variability are multifactorial. One possible explanation is the different definitions used for nephrotoxicity. Earlier studies did not utilize a standardized definition and generally reported lower rates of nephrotoxicity (4, 7). In more recent years, studies have used the risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria as a standardized definition for acute kidney injury (8). The rates of colistin-associated nephrotoxicity in these studies are more consistent, with a range between 31% and 48% (5, 6, 9-12). However, the reported risk factors associated with nephrotoxicity vary considerably in these studies. Thus, it is unclear which risk factors are most predictive of colistin-associated nephrotoxicity.With the high rate of nephrotoxicity associated with colistin use, identifying patients at high risk for developing nephrotoxicity is important for optimizing colistin therapy (i.e., weighing the risk versus benefits of initiating or continuing therapy). A direct comparison of the different mathematical models used to identify patients at high risk for colistin-associated nephrotoxicity has not been undertaken. To assess the clinical utility of various mathematical prediction models, the objectives of this study were to compare their performances in (i) predicting the overall risk of nephrotoxicity in a population of patients receiving colistin and (ii) identifying patients at high risk for developing colistin-associated nephrotoxicity.A literature search was conducted using PubMed to identify prediction models from published studies that evaluated independent risk factors for colistin-associated nephrotoxicity. Studies were included if they were published in English in the last 10 years and they defined nephrotoxicity according to the RIFLE criteria. The full logistic...

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mentioning

confidence: 99%

Validation of a Model To Predict the Risk of Nephrotoxicity in Patients Receiving Colistin

Phe

Johnson

Palmer

et al. 2014

Antimicrob Agents Chemother

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“…In some studies, concomitant NSAID or vancomycin use, hypertension, and older age were identified as independent risk factors for colistin-induced AKI (6,14,24,25), whereas these findings were not corroborated in several other studies, including ours (10,13,17,19,25,26).…”

Section: Discussionmentioning

confidence: 65%

“…The rates of colistin-induced AKI reported in the literature vary between 11z and 53.5z (3,4,6,9,10,(13)(14)(15)(16)(17). This variability could be attributed to the dose and duration of the therapies, and to the varying definitions of AKI.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

Gül

Kuşçu²,

Aydemir

et al. 2016

Jpn J Infect Dis

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“…Lamentablemente los estudios que buscaron analizar la incidencia de toxicidad renal para esta polimixina, carecen de uniformidad en las definiciones de falla renal, y esto mismo explica que se describan valores que fluctúan, en general, entre 10-50% [66][67][68][69][70][71][72][73][74][75][76][77] . No obstante lo anterior, es probable que actualmente la frecuencia de nefrotoxicidad sea más baja, ya que contamos con mejores unidades de pacientes críticos y preparados farmacéuticos más puros 78,79 .…”

Section: Toxicidadunclassified