Colistin-associated Acute Kidney Injury in Severely Ill Patients: A Step Toward a Better Renal Care? A Prospective Cohort Study.
BACKGROUND
Critically ill patients with severe sepsis or septic shock may need relatively high colistin daily doses for efficacy against multidrug-resistant and extensively drug-resistant gram-negative rods. However, acute kidney injury (AKI) may represent a major dose-limiting adverse effect of colistin. We sought to determine AKI occurrence and to identify factors influencing AKI risk in severely ill patients receiving colistin according to a recently proposed dosing strategy.


METHODS
A prospective, observational, cohort study involving patients with severe sepsis or septic shock who received colistin was performed. AKI was defined according to Acute Kidney Injury Network criteria. Colistin administration was driven by a modified pharmacokinetics-pharmacodynamics (PK/PD)-based dosing approach.


RESULTS
Of 70 patients who received colistin at a median daily dose of 9 million IU (MIU; interquartile range, 5.87-11.1 MIU), 31 (44%) developed AKI. In univariate analysis, age, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA), score and baseline renal impairment were significantly associated with AKI. Moreover, patients with AKI were less frequently treated with adjuvant ascorbic acid (P = .003). In multivariate analysis, independent predictors of AKI were baseline renal impairment (adjusted hazard ratio, 4.15; 95% confidence interval, 1.9-9.2; P < .001) and age (1.03; 1.0-1.05; P = .028), whereas a strong independent renal-protective role emerged for ascorbic acid (0.27; .12-.57; P < .001).


CONCLUSIONS
In severely ill patients receiving colistin according to a PK/PD-driven dosing approach, baseline renal impairment and older age strongly predict AKI occurrence, but concomitant administration of ascorbic acid markedly reduces AKI risk, allowing safer use of colistin.
['Dalfino|Lidia|L|', 'Puntillo|Filomena|F|', 'Ondok|Maria Josephine Mura|MJ|', 'Mosca|Adriana|A|', 'Monno|Rosa|R|', 'Coppolecchia|Sara|S|', 'Spada|Maria Luigia|ML|', 'Bruno|Francesco|F|', 'Brienza|Nicola|N|']
D058186:Acute Kidney Injury D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D000931:Antidotes D001205:Ascorbic Acid D032124:Blighia D003091:Colistin D016638:Critical Illness D005260:Female D016905:Gram-Negative Bacterial Infections D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D012307:Risk Factors D018805:Sepsis D055815:Young Adult
acute kidney injury critically ill colistin ascorbic acid colistimethate sodium