Association between colistin dose and development of nephrotoxicity

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Colistin is crucial for treating infections caused by extensively drug-resistant Gram-negative microorganisms.
• Nephrotoxicity is a significant concern with colistin therapy.
• The relationship between colistin dosage and nephrotoxicity, particularly concerning renal function, requires further investigation.

Purpose of the Study:

• To investigate the development of colistin-induced nephrotoxicity.
• To determine if the relationship between colistin dose and nephrotoxicity differs based on baseline renal function.

Main Methods:

• Retrospective cohort study of 329 adult patients receiving intravenous colistin for at least 72 hours.
• Colistin dosing evaluated by actual and ideal body weight.
• Nephrotoxicity defined as a doubling of baseline serum creatinine.

Main Results:

• 43.5% of patients experienced nephrotoxicity, with a median onset of 6 days.
• Higher median daily colistin dosing based on ideal body weight was associated with nephrotoxicity (p=0.021).
• Colistin dose was significantly associated with nephrotoxicity only in patients with estimated glomerular filtration rate <60 mL/min/1.73 m2 (OR, 2.34).

Conclusions:

• Colistin-induced nephrotoxicity is dose-dependent, but this effect is primarily observed in patients with impaired renal function.
• In patients with estimated glomerular filtration rate <60 mL/min/1.73 m2, a daily colistin dose of 2.87 mg/kg/d predicted nephrotoxicity.
• In patients with normal renal function, age, albumin, hematocrit, and glycopeptide use were associated with nephrotoxicity.