Risk factors of ceftriaxone-associated biliary pseudolithiasis in adults: influence of renal dysfunction

Area of Science:

• Pharmacology
• Nephrology
• Gastroenterology

Background:

• Ceftriaxone (CTRX) is a recognized cause of biliary pseudolithiasis (BPL), particularly in pediatric populations.
• Increased biliary elimination of CTRX in patients with renal dysfunction suggests a potential link to BPL.
• The impact of renal dysfunction on CTRX-associated BPL incidence in adults remains under-investigated.

Purpose of the Study:

• To determine the cumulative incidence of CTRX-associated BPL in adult patients.
• To evaluate whether renal dysfunction serves as an independent risk factor for CTRX-associated BPL.

Main Methods:

• Retrospective analysis of medical records for 478 patients treated with CTRX.
• Assessment of patient demographics, CTRX dosage and duration, and renal function markers (serum creatinine, eGFR).
• Calculation of cumulative BPL incidence using a competing risk model and identification of risk factors via multivariate Cox proportional hazards analysis.

Main Results:

• A significant proportion of patients (75.7%) exhibited renal dysfunction (eGFR < 60 mL/min).
• The cumulative incidence of BPL was substantially higher in patients with renal dysfunction compared to those with normal kidney function (4.1% vs. 0.6%, p=0.017).
• Multivariate analysis identified renal dysfunction (HR 7.93) and female sex (HR 4.65) as independent risk factors for CTRX-associated BPL.

Conclusions:

• Renal dysfunction is a significant and independent risk factor for the development of ceftriaxone-associated biliary pseudolithiasis in adult patients.
• The findings highlight the importance of considering renal function when prescribing ceftriaxone, especially in adult populations at risk for BPL.