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Azithromycin and Major Adverse Kidney Events in Critically Ill Patients With Sepsis-Associated Acute Kidney Injury
Michael L Behal1, Jonny L Nguyen2, Xilong Li3
1Department of Pharmacy Services, University of Kentucky HealthCare, Lexington, Kentucky.
Background:
Sepsis-associated acute kidney injury (SA-AKI) is associated with significant morbidity and mortality. Immune dysregulation is a hallmark of sepsis, with important contributions to organ dysfunction including injury and repair mechanisms in AKI. Macrolide antibiotics, such as azithromycin, have previously demonstrated in preclinical models a myriad of immunomodulatory effects that may benefit critically ill patients with SA-AKI. The aim of this study was to determine if early receipt of azithromycin in SA-AKI is associated with a reduction in major adverse kidney events (MAKE) at hospital discharge.
Methods:
This was a single center, retrospective cohort study of critically ill adult patients with SA-AKI. Early exposure to azithromycin was defined as receipt of one or more doses within 48 h of a hospital admission with SA-AKI. The primary outcome of MAKE assessed at hospital discharge was the composite of death, requirement for kidney replacement therapy, or a decline in estimated glomerular filtration rate of 25% or more. Multivariable logistic regression was used to account for potential confounders in the assessment.
Results:
Of 737 included patients with SA-AKI, 152 (20.6%) received azithromycin. Patients that received early azithromycin were less likely to experience MAKE at hospital discharge when compared to those patients not receiving azithromycin: 38.8% versus 48.4% (P = 0.035). In multivariable logistic regression, receipt of azithromycin was independently associated with a decreased odds of MAKE at hospital discharge (aOR 0.62, 95% CI 0.41-0.93).
Conclusions:
Early exposure to azithromycin in SA-AKI is independently associated with lower odds of MAKE at hospital discharge.
Insights
Early azithromycin use in sepsis-associated acute kidney injury (SA-AKI) may reduce major adverse kidney events (MAKE). This study found azithromycin was linked to lower odds of MAKE at hospital discharge for SA-AKI patients.
Area of Science:
- Nephrology
- Critical Care Medicine
- Infectious Diseases
Background:
- Sepsis-associated acute kidney injury (SA-AKI) significantly increases patient morbidity and mortality.
- Immune dysregulation in sepsis contributes to organ dysfunction, including kidney injury and repair processes.
- Macrolide antibiotics like azithromycin possess immunomodulatory effects with potential benefits in critical illness.
Purpose of the Study:
- To investigate the association between early azithromycin administration and major adverse kidney events (MAKE) in patients with SA-AKI.
- To evaluate the impact of azithromycin on kidney outcomes at hospital discharge for critically ill patients.
Main Methods:
- Retrospective cohort study involving critically ill adult patients diagnosed with SA-AKI.
- Early azithromycin exposure was defined as receiving at least one dose within 48 hours of hospital admission for SA-AKI.
- The primary outcome, MAKE, was a composite of death, need for kidney replacement therapy, or a ≥25% decline in estimated glomerular filtration rate at discharge. Multivariable logistic regression was employed to control for confounders.
Main Results:
- Out of 737 SA-AKI patients, 152 (20.6%) received early azithromycin.
- Patients receiving early azithromycin had a lower incidence of MAKE at discharge (38.8% vs. 48.4%, P=0.035).
- Multivariable analysis confirmed that azithromycin use was independently associated with reduced odds of MAKE (aOR 0.62, 95% CI 0.41-0.93).
Conclusions:
- Early azithromycin administration in SA-AKI patients is independently associated with a lower likelihood of experiencing major adverse kidney events.
- These findings suggest a potential protective role for early azithromycin in mitigating kidney-related complications in sepsis.
- Further prospective studies are warranted to confirm these results and elucidate the underlying mechanisms.
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