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Nephrotoxicity in Patients with and without Cystic Fibrosis Treated with Polymyxin B Compared to Colistin.
Antimicrob Agents Chemother. 2017 Feb 06;:
Authors: Crass RL, Rutter WC, Burgess DR, Martin CA, Burgess DS
Abstract
Nephrotoxicity is the primary adverse effect of the polymyxins. The relative rates of toxicity between polymyxin B and colistin have not been fully elucidated, especially in patients with cystic fibrosis (CF). A retrospective cohort study of adults treated with polymyxin B or colistin for at least 48 hours was conducted. The primary endpoint was the incidence of kidney injury by RIFLE (i.e., Risk, Injury, Failure, Loss, End-Stage Renal Disease) criteria. Risk factors for kidney injury were evaluated using multivariate Cox regression. A total of 414 patients were evaluated, 220 of whom had CF. In patients without CF, there was no difference in kidney injury with polymyxin B and colistin (42.9% versus 50.3%, p=0.46). Loop diuretics exposure was a risk factor for kidney injury (adjusted hazard ratio [aHR] 1.82, 95% confidence interval [CI] 1.16-2.83) in this population. In patients with CF, polymyxin B and colistin were associated with similar rates of kidney injury (34.5% versus 29.8%, p=0.77). Diabetes (aHR 2.68, 95% CI 1.01-7.11), loop diuretics (aHR 3.02, 95% CI 1.36-6.73), and progressive care unit admission (aHR 8.21, 95% CI 2.55-26.46) were risk factors for kidney injury while higher baseline serum creatinine (per 1 mg/dL) was protective (aHR 0.08, 95% CI 0.01-0.48). Total unadjusted kidney injury in polymyxin-treated patients was less frequent in those who had CF (30.5% vs 48.5%, p<0.001). Polymyxin B and colistin are associated with a high incidence of kidney injury; cystic fibrosis may be protective against polymyxin nephrotoxicity but further investigation is needed to confirm this finding.
PMID: 28167560 [PubMed - as supplied by publisher]