Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy

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• 作者：Christine J. Kubin^a ; ^b ; ^{cck27@columbia.edu} ; Tanya M. Ellman^b ; Varun Phadke^b ; Laura J. Haynes^c ; ^e ; David P. Calfee^d ; Michael T. Yin^b
• 关键词：Polymyxin B ; Nephrotoxicity ; RIFLE
• 刊名：Journal of Infection
• 出版年：2012
• 期刊代码：6_01634453
• 类别：imm
• 出版时间：July, 2012
• 卷：65
• 期：1
• 页码：80-87
• 文件大小：225 K

摘要

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Summary

Background

Increases in multidrug-resistance among gram-negative organisms have necessitated the use of polymyxins. To date, the incidence of acute kidney injury (AKI) associated with polymyxin B has not been evaluated using RIFLE criteria.

Methods

Adult patients who received polymyxin B were retrospectively evaluated to determine the incidence of AKI during polymyxin B therapy using RIFLE criteria. Predictors of AKI were identified by comparing characteristics of patients with and without AKI.

Results

A total of 73 patients were included. The incidence of AKI was 60%. Ten (14%) patients discontinued therapy due to nephrotoxicity. Median duration of polymyxin B was 11 days with a median cumulative dose of 18聽mg/kg. Concomitant nephrotoxins were received in 69 (95%). Patients with AKI had a higher median cumulative dose (1578聽mg vs. 800聽mg; p聽=聽0.02), a higher body mass index (BMI) (27.2 vs. 24.5聽kg/m²; p聽=聽0.03), and were more likely to receive vancomycin (82%vs. 55%; p聽=聽0.03) compared to those without AKI. After controlling for polymyxin B duration, independent predictors of AKI were higher BMI and concomitant vancomycin.

Conclusions

The incidence of AKI during polymyxin B therapy was 60%. Further studies are needed to define dosing parameters that maximize efficacy and minimize nephrotoxicity.