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Results: A total of 173 patients were included (once daily n=141, twice daily n=32). Median age was 68 years (IQR 56-79), CrCl was 65 mL/min (IQR 44-91), mAPACHE II score was 14 (12-16), PMB duration of therapy was 6 days (IQR 4-11), 59% of patients received concomitant nephrotoxic agents, and these were comparable between once and twice daily dosing. Overall, rate of AKI was 43% with once vs. 22% with twice daily dosing, P=0.04 with most cases being Risk category by RIFLE (18 vs. 16%, P=0.9). No patients met ESRD. In-hospital mortality was 19% with once vs. 28% with twice daily dosing, P=0.4. Time to AKI onset (7 vs. 8 days) and peak serum creatinine (SCr) (8 vs. 8 days) was similar with once vs. twice daily dosing. In multivariate model, severe sepsis (OR 4.2, 95% CI 1.6-11.3, P=0.005), receipt of >2 concomitant nephrotoxic agents (OR 2.6, 95% CI 1.0-6.7, P=0.045), PMB duration of therapy >10 days (OR 2.6, 95% CI 1.0-4.5, P=0.02) and total dose >1,500,000 units/day (OR 2.1, P=0.05) were identified as an independent predictors of AKI, but not once daily dosing (OR 2.6, 95% CI 0.9-7.1, P=0.075).

Nephrotoxicity associated with intravenous (IV) polymyxin B (PMB) once versus twice daily dosing