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J Antimicrob Chemother. 2015 May;70(5):1552-7. doi: 10.1093/jac/dku561. Epub 2015 Jan 20.

Risk factors for acute kidney injury (AKI) in patients treated with polymyxin B and influence of AKI on mortality: a multicentre prospective cohort study.

Author information

1
Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
2
Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil.
3
Infection Control Service, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
4
Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
5
Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto, Alegre, Brazil azavascki@hcpa.ufrgs.br.

Abstract

OBJECTIVES:

The objectives of this study were to assess risk factors for acute kidney injury (AKI) in patients treated with polymyxin B, a last resort antibiotic against Gram-negative bacteria, with a focus on dose, and to determine the impact of AKI on mortality of these patients.

METHODS:

A multicentre prospective cohort study was performed including patients ≥18 years treated with intravenous polymyxin B for ≥48 h. The primary outcome was AKI defined by RIFLE criteria. Secondary outcomes were 30 day mortality and failure stage of AKI. Multivariate analysis with a Cox regression model was performed. The probability of developing AKI was determined in a logistic regression model.

RESULTS:

Four-hundred-and-ten patients were included. AKI occurred in 189 (46.1%) patients. Polymyxin B dose ≥150 mg/day was a risk factor for AKI: adjusted HR = 1.95, 95% CI = 1.31-2.89, P = 0.01. Higher weight and age were also independently associated with AKI. The probability of developing AKI significantly increased with doses between 150 and 199 mg/day, regardless of patient weight, with no significant increase with higher doses. Higher weight also increased the risk in patients receiving the same daily doses. AKI was barely associated with increased risk for 30 day mortality (adjusted HR = 1.35, 95% CI = 0.99-1.85, P = 0.06), while ≥150 mg/day did not increase this risk despite its association with AKI.

CONCLUSIONS:

Polymyxin B total dose is highly related to the risk of AKI, regardless of patient weight. Thirty-day mortality tended to be higher in patients who developed AKI. The relationship between dose, AKI and mortality must be further investigated in studies specifically designed to evaluate this latter outcome.

KEYWORDS:

PMB; colistin; nephrotoxicity

PMID:
25604744
DOI:
10.1093/jac/dku561
[Indexed for MEDLINE]

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