Clinical Significance of Acute Kidney Injury in Patients with Colistin Treatment

Nam, Woo Jin; Shin, Jung Ho; Han, Min Jee; Park, Youn Su; Kim, Su Hyun; Oh, Dong Jin; Yu, Suk Hee

Abstract

PURPOSE
Colistin (colistimethate sodium) became available for clinical use in 1959 and was used until the early 1980s to treat infections caused by Gram-negative rods. It was abandoned during the last two decades mainly due to its significant nephrotoxicity. However, the emergence of multidrug-resistant (MDR) bacteria such as Pseudomonas aeruginosa and Acinetobacter baumanii has resulted in significantly increased use of intravenous colistin. This study was designed to investigate the incidence and risk factors of acute kidney injury (AKI) associated with intravenous colistin (colistimethate sodium) treatment.
METHODS
We retrospectively collected the data from patients who were admitted to Chung-Ang University Hospital and treated with colistin from May 2007 to June 2009. Among these, we excluded the patients with baseline glomerular filtration rate (GFR) less than 15 ml/min/1.73m2. AKI was defined as an increase of creatinine more than 150% from the baseline, according to RIFLE criteria.
RESULTS
A total of 92 patients met the inclusion criteria and were included in the analysis. AKI occurred in 43 (47%) of the 92 patients. The cumulative doses (2.51+/-1.89 vs. 1.75+/-1.35 g, p=0.032) of colistin were significantly greater in the AKI group than in the normal kidney function (NKF) group. Serum creatinine level showed a significant increase in the AKI group, from day 3 (1.6+/-1.1 vs. 0.9+/-0.5 mg/dL, p=0.001) to day 90 (2.1+/-1.9 vs. 0.7+/-0.2 mg/dL, p=0.033). Furthermore, the occurrence of AKI at day 3 was a significant predictor of shorter survival (Log rank test p=0.031).
CONCLUSION
AKI was a relatively common side effect of colistin. The cumulative dose was critical, rather than the daily dose or duration of treatment. Early acute kidney injury may predict shorter cumulative survival in patients undergoing colistin treatment.