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Risk of polymyxin B-induced acute kidney injury with a non adjusted dose versus adjusted dose based on renal function

Guanhao Zheng1,2, Jiaqi Cai3, Shenghui Zhou4

  • 1Department of Pharmacy, Ruijin Hospital Affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, 200000, China.

Personalized Medicine
|June 28, 2022
PubMed

Insights

Dose adjustment of polymyxin B (PMB) based on kidney function did not significantly reduce acute kidney injury (AKI) risk. A non-adjusted dosing strategy is recommended for patients with varying renal impairment.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Polymyxin B (PMB) is a critical antibiotic for treating multidrug-resistant Gram-negative infections.
  • Acute kidney injury (AKI) is a significant adverse effect associated with PMB treatment.
  • Optimal dosing strategies for PMB in patients with renal impairment are still debated.

Purpose of the Study:

  • To compare the incidence of PMB-induced AKI between patients receiving PMB with dose adjustment versus those receiving standard dosing.
  • To evaluate the impact of renal function-based PMB dose adjustment on secondary clinical outcomes.

Main Methods:

  • Retrospective cohort study involving 115 patients treated with PMB from November 2018 to October 2019.
  • Patients were divided into two groups: those with PMB dose adjustment based on renal function and those without.
  • Incidence of AKI and secondary outcomes were compared between the groups.

Main Results:

  • No statistically significant difference in AKI incidence was observed between the dose-adjusted group (47.5%) and the non-adjusted group (37.14%; p = 0.304).
  • Secondary outcomes also showed no significant differences between the two treatment strategies.
  • The study did not find evidence supporting the benefit of PMB dose adjustment for reducing AKI risk.

Conclusions:

  • Renal function-based dose adjustment of polymyxin B does not significantly reduce the risk of acute kidney injury.
  • A non-adjusted dosing strategy for PMB may be appropriate for patients with varying degrees of renal impairment.
  • Further prospective studies are warranted to confirm these findings and optimize PMB therapy.
Keywords:
acute kidney injurydose adjustmentnephrotoxicitypolymyxin Brenal function

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