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Prevalence and risk factors for acute kidney injury associated with parenteral polymyxin B use
Carlos A C Mendes1, José A Cordeiro, Emmanuel A Burdmann
1Internal Medicine Department, Division of Internal Medicine, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil.
Background:
The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury.
Objective:
To assess the prevalence of and risk factors for acute kidney injury (AKI) in patients treated with polymyxin B.
Methods:
The studied population included 114 patients who received at least 3 consecutive days of intravenous polymyxin B and had baseline serum creatinine (SCr) and at least one further SCr measurement during treatment. AKI was defined as an SCr increase to 1.8 mg/dL or greater in patients with baseline SCr less than 1.5 mg/dL, or an increase greater than or equal to 50% in baseline SCr when it was already greater than or equal to 1.5 mg/dL, or need for dialysis.
Results:
AKI developed in 22% of the patients. They were older, had a higher baseline SCr, had a higher frequency of baseline SCr greater than or equal to 1.5 mg/dL, used other nephrotoxic drugs and furosemide more often, and required vasoactive drugs and mechanical ventilation more frequently. Progression to renal failure was significantly more probable when the bacteria were isolated in the abdomen, catheter, or blood. AKI patients had a higher mortality rate (92% vs 53%; p < 0.001). Logistic regression identified abnormal baseline SCr (odds ratio [OR] 3.51); need for vasoactive drugs (OR 3.03); and abdomen, blood, or catheter as the infection site (OR 3.82) as independent risk factors for AKI.
Conclusions:
Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site.
Insights
Polymyxin B can cause acute kidney injury (AKI) in 22% of patients, leading to higher mortality. Risk factors include abnormal baseline serum creatinine and use of vasoactive drugs.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- Polymyxin B is associated with nephrotoxicity, a significant adverse effect.
- Limited data exists on the incidence and risk factors of polymyxin-induced renal injury.
Purpose of the Study:
- To determine the prevalence of acute kidney injury (AKI) in patients receiving polymyxin B.
- To identify risk factors associated with polymyxin B-related AKI.
Main Methods:
- A cohort of 114 patients receiving intravenous polymyxin B for at least 3 days was analyzed.
- AKI was defined by specific serum creatinine criteria or need for dialysis.
Main Results:
- 22% of patients developed AKI, with higher mortality rates observed (92% vs 53%).
- Independent risk factors for AKI included abnormal baseline serum creatinine, need for vasoactive drugs, and infection site (abdomen, blood, catheter).
Conclusions:
- AKI in polymyxin B-treated patients is associated with significantly elevated mortality.
- Caution is advised when using polymyxin B in patients with pre-existing renal abnormalities, those requiring vasoactive drugs, or with specific infection sites.
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