Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria

Abstract

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.

Fig 1. Rates of acute kidney injury by baseline (A) serum creatinine value and (B) creatinine clearance.

Note (A). Rates of acute kidney injury were significantly higher for patients with a baseline serum creatinine value ≥1.01 mg/dL compared to ≤0.6 mg/dL at 48 hours (P = 0.01) and 7 days (P = 0.01).