The Colistin-related nephrotoxicity and risk factors in the intensive care unit; a retrospective study

Abstract

Objective: Colistimethate sodium (CMS) which is salvage therapy in the management of infections caused by multi-drug resistance (MDR) gram-negative pathogens is eliminated by the kidneys and cause nephrotoxicity. Many factors may also contribute to this nephrotoxic effect. In this study we aimed to determine the risks for the development of nephrotoxicity patients who received CMS in the intensive care unit (ICU).
 Materials and Methods: We evaluated retrospectively of the patients who have lung cancer or COPD, aged older than 18 years, and received intravenous CMS therapy at least 72 hours in ICU. Patients’ age, comorbidities, C-reactive protein (CRP), procalcitonin, albumin, glomerular filtration rate (GFR), creatinine values on the 1st and 7th days of CMS treatment, positive inotropes, and nephrotoxic drugs used concurrently with CMS therapy, and renal replacement therapy (RRT) were recorded. RIFLE score , lenght of stay (LOS) in hospital and in the ICU, and 28-day mortality were also recorded.
 Results: In this study, the GFR and creatinine level deteriorated significantly on the 7th day with CMS therapy patients who had preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage. The incidence of acute kidney injury was higher in malignant patients and 28-day mortality increased in patients with nephrotoxicity.
 Conclusion: The CMS therapy with preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage significant risk factors to develop nephrotoxicity. It was also higher in malignant patients and increased 28-day mortality. Detailed clinical and laboratory evaluation of the patients is needed before CMS treatment.