A review on colistin nephrotoxicity

Area of Science:

• Pharmacology and Toxicology
• Nephrology
• Infectious Diseases

Background:

• Colistin, an older antibiotic, was withdrawn due to nephrotoxicity but has re-emerged for treating multi-drug resistant Gram-negative infections.
• Increased usage and high-dose regimens raise significant concerns about colistin-induced kidney injury.

Purpose of the Study:

• To review the prevalence, mechanisms, risk factors, and prevention strategies for colistin nephrotoxicity.
• To provide a comprehensive overview of colistin's adverse effects on renal function, particularly at high doses.

Main Methods:

• Systematic literature search conducted in PubMed, Scopus, and Cochrane databases.
• Keywords included "colistin", "nephrotoxicity", "renal failure", "high dose", and "risk factor".
• Inclusion of randomized clinical trials and observational studies (animal and human); 60 articles reviewed.

Main Results:

• Colistin is a nephrotoxic antibiotic, with increased usage due to rising nosocomial infections.
• Nephrotoxicity mechanisms involve increased tubular epithelial cell membrane permeability, leading to cell damage.
• Oxidative and inflammatory pathways also contribute to colistin-induced kidney injury.

Conclusions:

• Colistin nephrotoxicity is a significant concern, influenced by dose, duration, co-administered drugs, and patient-specific factors.
• Risk factors include high colistin doses, concurrent nephrotoxic agents, advanced age, hypoalbuminemia, and severe illness.
• Understanding these factors is crucial for preventing and managing colistin-related kidney injury.