Abstract: SA-PO026

Risk Factors for Polymyxin-Induced AKI in Critically Ill Patients

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • da Fonseca, Cassiane Dezoti, School of Nursing, University of São Paulo, Carapicuíba, Brazil
  • Watanabe, Mirian, University of Sao Paulo, Sao Paulo, Brazil
  • Vattimo, Maria De Fatima, None, Sao Paulo, SÃO PAULO, Brazil
  • Fernandes, Sheila Marques, School of Nursing, University of São Paulo, Carapicuíba, Brazil
  • Santos, Luciana soares Costa, Universidade de São Paulo, SÃO PAULO, Brazil
  • Coelho, Filipe U, University of São Paulo, São paulo, Brazil
  • Oliveira, Natalia Abreu de, Organization University of São Paulo, São Paulo, Brazil

Group or Team Name

  • Research Group on Acute Kidney Injury-GERA
Background

Critically ill patients with infections and sepsis frequently need robust antimicrobial agents, such as polymyxins (Pmxs), for efficacy against multi-resistant gram-negative bacteria. However, acute kidney injury (AKI) may be the most important limiting adverse effect of Pmxs. This study evaluated the incidence and identified the risk factors for the development of AKI in critically patients receiving Pmxs.

Methods

A multicenter retrospective cohort study enrolling 1009 intensive care patients Wwas performed. AKI was defined by KDIGO criteria. Primary outcome was patients who received Pmxs and developed AKI. The main secundary outcomes were clinical risk factors for Pmxs-induced AKI. Multivariate analyses with logistic regression were performed.

Results

A total of 936 patients were included. AKI was detected in 404 (43%) patients. Mean age was 59.1 ± 17.0 years, 63% were male. Systemic arterial hypertension (45%), Diabetes Mellitus (26%), sepsis (22%) and shock state (57%) were observed in AKI individuals. The mortality was 37% for AKI patients (P<0.001). Among 75 patients treated with Pmxs, rate of AKI was 88%. The risk factor of AKI associated with Pmxs were prolonged hospital stay, mechanical ventilation and shock state (P<0.001).

Conclusion

This data highligted that the rate of Pmx-induced AKI was greather than other studies. Critically ill patients are at higher risk due to the presence of prolonged hospital stay, mechanical ventilation and shock state.

Risk factor of AKI associated polymyxins use
VariableOR (IC 95%)p value
Age0.05 (0.9-1.0)0.059
Shock4.91 (1.6-14.8)0.005
Vasoactive drug0.59 (0.2-1.3)0.212
Mechanical ventilation1.07 (1.0-1.1)<0.001
Clinical hospitalization1.39 (0.7-2.7)0.337
ICU hospital stay1.09 (1.0-1.1)<0.001

Figure 1. Survivel curve of patients in use of polymyxins.

Funding

  • Government Support - Non-U.S.