Acute kidney injury following colistin treatment in critically-ill patients: may glucocorticoids protect?

Abstract

Nephrotoxicity following colistin administration is common and factors alleviating nephrotoxicity are yet to be determined. We retrospectively evaluated outcomes of subjects who were treated with colistin (n = 133) and with antibiotics other than colistin (control, n = 133) in intensive care units. Acute kidney injury (AKI) occurred in 69.2% and 29.3% of patients in colistin and control groups, respectively (p < 0.001). In the colistin group, glucocorticoid exposure was more common in subjects who did not develop AKI (p < 0.001). This was not the case in the control group. In the colistin cohort, older age (per 10 years, odds ratio [OR] 1.41, 95% CI 1.05–1.91; p = 0.025), PPI use (OR 3.30, 95% CI 1.18–9.23; p = 0.023) and furosemide treatment (OR 2.66, 95% CI 1.01–6.98; p = 0.047) were independently associated with the development of AKI while glucocorticoid treatment (OR 0.23, 95% CI 0.10–0.53; p = 0.001) was independently associated with reduced risk of AKI. Mortality was observed in 74 patients in the colistin cohort (55.6%). A higher APACHE-II score (OR 1.17, 95% CI 1.08–1.26; p < 0.001) was independently associated with mortality while a higher serum albumin level (per 1 g/dL increase, OR 0.20, 95% CI 0.070–0.60; p = 0.004) was associated with a lower risk of mortality. In conclusion, glucocorticoid exposure is associated with a lower risk of AKI caused by colistin therapy in critically-ill patients. Prospective studies are needed to confirm these findings and determine the optimal type, dose and duration of glucocorticoid therapy.

Keywords:

• Acute-kidney injury
• Anti-infective agents
• Colistin
• Critical care
• Glucocorticoids
• Gram-negative bacteria
• Kidney

Conflict of interest

The authors report no conflict of interest.

Notes on contributors

Cihan Heybeli, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology. Research Interests: Glomerular disorders, Drug-induced nephrotoxicities, Amyloidosis, Monoclonal gammopathy of renal significance, Onco-nephrology.

Kübra Canaslan, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine.

Mehmet Ası Oktan, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology.

Serkan Yıldız, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology.

Hayri Üstün Arda, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology.

Caner Çavdar, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology.

Ali Çelik, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Nephrology.

Necati Gökmen, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Anesthesiology and Reanimation.

Bilgin Cömert, MD. Professor of Medicine. Dokuz Eylul University School of Medicine, Department of Internal Medicine Division of Intensive Care Medicine