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Effect of aminoglycoside use on residual renal function in peritoneal dialysis patients

D Shemin1, D Maaz, D St Pierre

  • 1Division of Renal Diseases, Rhode Island Hospital, Providence, RI, USA. douglas_shamin@brown.edu

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|July 13, 1999
PubMed

Insights

Parenteral aminoglycosides accelerate the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. Withholding these nephrotoxic antibiotics may preserve RRF, crucial for solute clearance and patient outcomes.

Area of Science:

  • Nephrology
  • Pharmacology
  • Clinical Medicine

Background:

  • Residual renal function (RRF) is vital for solute clearance in peritoneal dialysis (PD) patients, impacting morbidity and mortality.
  • Few studies have investigated factors affecting RRF in PD patients.
  • Aminoglycosides are known nephrotoxins in the general population.

Purpose of the Study:

  • To examine the impact of parenteral aminoglycosides on RRF in PD patients.
  • To compare the decline in RRF among PD patients with varying exposure to peritonitis and aminoglycosides.

Main Methods:

  • Prospective observational study of 72 PD patients over 4 years.
  • Measurement of 24-hour renal creatinine clearance and urine volume every 4-6 months.
  • Patients categorized into three groups based on peritonitis and antibiotic exposure (no antibiotics, non-aminoglycoside antibiotics, aminoglycosides).

Main Results:

  • Patients receiving IV or IP aminoglycosides (Group III) showed a significantly more rapid decline in renal creatinine clearance (-0.66 mL/min/mon) compared to Groups I and II (P < 0.005).
  • Group III also exhibited a more rapid decline in daily urine volume (-74 mL/d/mon) than Groups I and II (P < 0.01).

Conclusions:

  • Parenteral aminoglycosides appear to accelerate the decline of RRF in PD patients.
  • Withholding aminoglycosides in PD patients reliant on RRF for solute clearance is advisable, especially when alternative antibiotics are suitable.

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