Abstract
Background: Colistin is an old antibiotic and used for resistant gram-negative infections. Nephrotoxicity is the most common side effect and restricts clinicians to use it. Many risk factors suggested for the development of nephropathy. It could be better to know risks to prevent nephropathy development. Objectives: In this study, we aimed to evaluate factors that affecting the development of nephropathy in patients who were hospitalized in hematology, oncology, palliative care, and intensive care units. Methods: 125 patients aged 20-93 years old were enrolled in this retrospective study. Data were obtained from the pharmacy of the university hospital and information management system of the hospital. Results: Among 125 patients included in the study, 15 developed KDIGO stage 1 nephropathy, 21 stages two nephropathies, and four stages three nephropathies, respectively. Age, albumin level, and bilirubin levels were shown to be related to nephropathy. We found the cut off value of albumin 3.05 mg/dl for development of nephropathy (sensitivity 70%; specificity 66%; CI=95%, p=0.003) and mortality (sensitivity 69%; specificity 61%; CI=95%, p<0.001). We revealed that age and bilirubin levels independently affected the development of nephropathy in linear regression analysis (r2 =0.131, p=0.032; p=0.015). Also, mortality was denoted to be related to albumin and bilirubin levels independently in linear regression analysis (r2 =0.161, p=0.03; p=0.004). Conclusions: Older age, hypoalbuminemia, and hyperbilirubinemia were risk factors for colistin related nephropathy and mortality. Further studies will be better to elucidate relationships more clearly.  Â
Highlights
Polymyxins are cationic cyclic polypeptide antibiotics that identified as fermentation products of the bacteria Bacillus polymyxa(Yu et al 2018)
Our study revealed that serum albumin levels were inversely related to nephropathy and mortality
Albumin level was found to be independently associated with nephropathy when we did linear regression analysis with albumin level and bilirubin level (r2 =0.096, p=0.028), but when we added age to parameters albumin level became not related with nephropathy (r2 =0.131, p=0.124)
Summary
Polymyxins are cationic cyclic polypeptide antibiotics that identified as fermentation products of the bacteria Bacillus polymyxa(Yu et al 2018). The major drawback of colistin use for resistant gram-negative infections is nephrotoxicity. Some of them are increased age, comorbid conditions, prolonged time of treatment, high doses, use of other nephrotoxic agents, pre-existing renal failure, hypertension, and obesity (Shields et al 2017). In addition to these factors, hyperbilirubinemia and hypoalbuminemia are some other risk factors suggested to be related to colistin nephrotoxicity Conclusions: Older age, hypoalbuminemia, and hyperbilirubinemia were risk factors for colistin related nephropathy and mortality. Further studies will be better to elucidate relationships more clearly
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