Changes in Renal Function by Nebulized Colistimethate Treatment

Ahn, Hye Jin; Jung, Yoo Jin; Kim, Jae Song; Kim, Soo Hyun; Son, Eun Sun

Abstract

BACKGROUND
Nebulized colistimethate is increasingly used, because there are problems such as renal dysfunction and low distribution within the lungs when colistimethate is administered intravenously. This study was designed to compare and analyze the changes in renal function by of nebulized colistimethate treatment for its safe administration.
METHODS
This study retrospectively reviewed the electronic medical records of adult patients above 19 years old, receiving only the nebulized colistimethate at least 4 days in Yonsei university health system from Nov 2014 to Aug 2015. Acute kidney injury (AKI) was determined by using the RIFLE criteria (Risk, Injury, Failure, Loss and End-stage renal disease) according to serum creatinine (SCr) levels before and after use of nebulized colistimethate.
RESULTS
48 patients were included our study and their SCr increased significantly after nebulized colistimethate treatment (SCrâ‚€ vs. SCrâ‚; 0.85±0.80 vs. 1.00±0.82 mg/dL, n=48, p<0.001), but the changes were in normal range according to the standards at Yonsei university health system(a). Among 48 patients, 38 patients were in the non-AKI group (79.2%), and 10 patients developed AKI (20.8%). Within the AKI group, 2 patients were in the Injury group (20%) and the other 8 in the Risk group (80%).
CONCLUSION
There was no significant difference in age, dosage and duration of treatment between AKI group and non-AKI group (p>0.05). The study has a significance in that it reviewed the safety of nebulized colistimethate only treatment to national patients, analyzing its nephrotoxicity. It has confirmed that nebulized colistimethate is a safer method than intravenous injection, and requires to establish a guideline for the use of nebulized colistimethate in further studies with broader patient groups. (a): SCr Male 0.68-1.19 mg/dL, Female 0.49-0.91 mg/dL