Abstract: SA-PO028

Colistimethate Sodium and AKI: Incidence, Evolution, Risk Factors, and Prognosis

Session Information

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Author

  • Pampa-Saico, Saul, Hospital Ramon y Cajal, MADRID, MAD, Spain
Background

Colistimethate sodium (CMS) treatment has increased in the last years due to exponential increase in multidrug-resistant bacterial infections with the risk of CMS nephrotoxicity.The aim of this study was to determine the incidence and risk factors of AKI attributable to CMS based on KDIGO criteria. To identify prognostic factors which conditioning kidney function outcome at six months of follow-up.

Methods

Retrospective observational study, including patients >18 years old admitted from January 2007 to December 2013 who received CMS for > 48hours. Demographic, clinical and biochemical parameters of prognostic interest were collected. A multivariate logistic regression analysis was used to identify the risk factors associated with the development of AKI. To evaluate the renal function outcomes at 6 months after discharge (by eGFR (MDRD-4)) were analyzed by multivariate lineal regression. Unfavorable kidney evolution at six months was defined as residual impairment of kidney function indicated by a eGFR less than 60 ml/min/m2 or a reduction of creatinine clearance >25% at 3 months in comparison with baseline

Results

126 patients (mean age 64.4±14 years) were included in the study; 61 patients developed AKI (48%). Independent predictors of AKI were the infection grade: severe sepsis (OR 3.1; p=0.026); septic shock (OR 11.9; p=0.0004), intravenous iodinated contrast media (OR 2.9; p=0.024) and serum creatinine at hospital admission (OR 2.9, p=0.031). Eighty-four patients (67%) survived at discharge. Independent predictors of decline in renal function after 6 months were eGFR at hospital admission (p=0.016) and hospital discharge (p=0.0004) (R2c= 0.823). 56% (34/61) patients who developed AKI during admission survived, 32% of them (11/34) had an unfavorable kidney outcome at 6 months, the main determinants were eGFR at hospital admission (p=0.023), at the start CMS (p=0.002) and at hospital discharge (p=0.0003).

Conclusion

The development of AKI associated with CMS treatment was correlated with the infection grade, intravenous iodinated contrast and serum creatinine at hospital admission. Neither doses nor length of therapy with CMS were associated with AKI. The eGFR levels at hospital admission and hospital discharge were independently factors associated with renal function outcome at six months. These predictors may assist in clinical decision making for this patient population.