Open AccessDefining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria
Author(s) -
Ryan K. Shields,
Rohit Anand,
Lloyd Clarke,
Julie Paronish,
Matthew P. Weirich,
Hanna Perone,
Jake Kieserman,
Henry R. Freedy,
Christina Andrzejewski,
Hector Bonilla
Publication year - 2017
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0173286
Subject(s) - colistin , medicine , acute kidney injury , incidence (geometry) , kidney disease , concomitant , intensive care unit , intensive care medicine , logistic regression , antibiotics , physics , optics , microbiology and biotechnology , biology
Background Acute kidney injury (AKI) remains a treatment-limiting toxicity of colistin. Recently developed clinical practice guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) group have harmonized definitions of AKI, but have not been widely applied to patients receiving colistin. Methods We retrospectively defined AKI by KDIGO definitions among adult patients receiving intravenous colistin for ≥ 3 days. Risk factors for AKI within 48 hours and 7 days of initiating colistin were determined by multivariable logistic regression. Results Among 249 patients treated with colistin, rates of AKI were 12% and 29% at 48 hours and 7 days, respectively. At 48 hours, patients in the intensive care unit were at increased risk for AKI. Within 7 days, colistin daily doses >5mg/kg, chronic liver disease, and concomitant vancomycin were independent predictors. Seven percent of patients required renal replacement therapy at a median of 5 days (range: 3–7) following colistin initiation. Conclusion Safe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.