Trough colistin plasma level is an independent risk factor for nephrotoxicity: A prospective observational cohort study

Luisa Sorlí*, Sonia Luque, Santiago Grau, Núria Berenguer, Concepción Segura, María Milagro Montero, Francisco Álvarez-Lerma, Hernando Knobel, Natividad Benito, Juan P. Horcajada

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

111 Citations (Scopus)

Abstract

Background: Data regarding the most efficacious and least toxic schedules for the use of colistin are scarce. The aim of this study was to determine the incidence and the potential risk factors of colistin-associated nephrotoxicity including colistin plasma levels.Methods: A prospective observational cohort study was conducted for over one year in patients receiving intravenous colistin methanesulfonate sodium (CMS). Blood samples for colistin plasma levels were collected immediately before (Cmin) and 30 minutes after CMS infusion (Cmax). Renal function was assessed at baseline, on day 7 and at the end of treatment (EOT). Severity of acute kidney injury (AKI) was defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria.Results: One hundred and two patients met the inclusion criteria. AKI related to CMS treatment on day 7 and at the end of treatment (EOT) was observed in 26 (25.5%) and 50 (49.0%) patients, respectively. At day 7, Cmin (OR, 4.63 [2.33-9.20]; P < 0.001) was the only independent predictor of AKI. At EOT, the Charlson score (OR 1.26 [1.01-1.57]; P = 0.036), Cmin (OR 2.14 [1.33-3.42]; P = 0.002), and concomitant treatment with ≥ 2 nephrotoxic drugs (OR 2.61 [1.0-6.8]; P = 0.049) were independent risk factors for AKI. When Cmin was evaluated as a categorical variable, the breakpoints that better predicted AKI were 3.33 mg/L (P < 0.001) on day 7 and 2.42 mg/L (P < 0.001) at EOT.Conclusions: When using the RIFLE criteria, colistin-related nephrotoxicity is observed in a high percentage of patients. Cmin levels are predictive of AKI. Patients who receive intravenous colistin should be closely monitored and Cmin might be a new useful tool to predict AKI.

Original languageAmerican English
Article number380
JournalBMC Infectious Diseases
Volume13
Issue number1
DOIs
Publication statusPublished - 19 Aug 2013

Keywords

  • Colistin
  • Colistin plasma levels
  • Nephrotoxicity risk factors
  • RIFLE criteria

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