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Comparative nephrotoxicity of polymyxin B versus colistin: evidence from ensemble learning and propensity score
Murat Özdede1,2, Fatma Nisa Balli Turhan3, Özgenur Geridönmez4
1Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Türkiye.
Background:
Polymyxins are last-resort antibiotics for multidrug-resistant Gram-negative infections, but their nephrotoxicity limits clinical use.
Objectives:
To compare the nephrotoxicity of colistin versus polymyxin B and identify risk factors for acute kidney injury (AKI).
Methods:
We retrospectively analysed 258 patients (132 colistin, 126 polymyxin B) with normal to moderately impaired renal function. Machine learning (ML) algorithms predicted AKI risk, and propensity score matching was used to evaluate the risk of colistin preference over polymyxin B.
Results:
Colistin nephrotoxicity (defined as at least stage II KDIGO AKI) was significantly more frequent with colistin than polymyxin B in both unmatched (for colistin 31% versus for polymyxin B 19%, P = 0.04) and matched cohorts (34.4% for colistin versus 14.1% for polymyxin B, P = 0.01). ML identified lower baseline eGFR, higher uric acid, hypalbuminaemia, higher age, concomitant nephrotoxic drug use, weight, vasopressor use and polymyxin type as top predictors. Colistin preference over polymyxin B resulted in significant nephrotoxicity risk in both unmatched (OR: 2.08, 95% CI [1.14-3.79]) and matched cohorts (OR: 3.42, 95% CI [1.38-8.5]). Complete renal recovery occurred in only 41% of AKI cases within 30 days.
Conclusions:
Colistin demonstrates significantly higher nephrotoxicity than polymyxin B. The complex relationship between baseline renal function and AKI risk suggests careful monitoring for patients with moderate renal impairment, regardless of polymyxin choice.
Insights
Colistin causes significantly more kidney damage than polymyxin B in patients with multidrug-resistant infections. Careful monitoring is crucial for patients with moderate kidney impairment when using these last-resort antibiotics.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Polymyxins are critical for treating multidrug-resistant Gram-negative infections.
- Nephrotoxicity of polymyxins restricts their clinical application.
- Understanding comparative nephrotoxicity is vital for patient safety.
Purpose of the Study:
- To compare the nephrotoxicity of colistin and polymyxin B.
- To identify risk factors for acute kidney injury (AKI) associated with polymyxin use.
- To evaluate the impact of choosing colistin over polymyxin B.
Main Methods:
- Retrospective analysis of 258 patients treated with colistin or polymyxin B.
- Machine learning algorithms used to predict AKI risk.
- Propensity score matching to control for confounding factors.
Main Results:
- Colistin was associated with significantly higher nephrotoxicity than polymyxin B in both unmatched and matched cohorts.
- Key predictors of AKI included lower baseline eGFR, higher uric acid, hypalbuminemia, age, and concomitant nephrotoxic drug use.
- Choosing colistin over polymyxin B increased the risk of nephrotoxicity.
Conclusions:
- Colistin exhibits greater nephrotoxicity compared to polymyxin B.
- Patients with moderate renal impairment require vigilant monitoring irrespective of the polymyxin agent chosen.
- Further research into optimizing polymyxin use is warranted.
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