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Clinical characteristics and risk factors of colistin-induced nephrotoxicity

Jieun Kim1, Kyoung-Ho Lee, Sunmi Yoo

  • 1Department of Internal Medicine, Hanyang University College of Medicine, 17 Haengdang-dong, Sungdong-gu, Seoul 133-792, South Korea.

International Journal of Antimicrobial Agents
|September 4, 2009
PubMed

Insights

Colistin reintroduction for multidrug-resistant infections led to high nephrotoxicity rates. Hypoalbuminemia and NSAID use were identified as significant risk factors for this colistin-induced kidney damage.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Increasing prevalence of multidrug-resistant gram-negative organisms necessitates the re-emergence of polymyxin E (colistin) as a critical therapeutic option.
  • Colistin's reintroduction is tempered by its known nephrotoxicity, prompting further investigation into its renal impact.

Purpose of the Study:

  • To investigate the incidence, clinical characteristics, and risk factors associated with colistin-induced nephrotoxicity.
  • To identify patient-specific and treatment-related factors that predispose individuals to kidney damage during colistin therapy.

Main Methods:

  • A case-control study design was employed, including 47 patients who received at least one defined daily dose (DDD) of intravenous colistin between August 2006 and June 2008.
  • Data collection focused on incidence of nephrotoxicity, clinical presentation, co-administered medications, and patient factors such as hypoalbuminemia.

Main Results:

  • Colistin-induced nephrotoxicity was observed in 31.9% of patients (15 out of 47), with 20% of these requiring renal replacement therapy.
  • Hypoalbuminemia and the concomitant use of non-steroidal anti-inflammatory drugs (NSAIDs) were identified as significant independent risk factors for nephrotoxicity in logistic regression analysis.
  • A high rate of renal function recovery (90%) was noted in patients reassessed after one month.

Conclusions:

  • Colistin-induced nephrotoxicity occurs frequently and is associated with significant risk factors.
  • Hypoalbuminemia and concurrent NSAID administration are critical factors that increase the risk of nephrotoxicity during colistin treatment.
  • These findings suggest that careful patient selection and monitoring, particularly regarding albumin levels and NSAID use, are crucial when administering colistin.

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