Kidney Week

Abstract: FR-PO0397

AKI and Major Adverse Kidney Events During Colistin Therapy: Clinical Predictors and Prognostic Implications

Session Information

• AKI: Biomarkers, Diagnostics, and Risk Prediction
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Chavez, Jonathan, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Jonathan Chavez, MD, PhD

• Alcantar Vallin, Maria de la Luz, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Maria de la Luz Alcantar Vallin, MD

• Medina, Ramon, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Ramon Medina, MD

• Martínez Gallardo González, Alejandro, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Alejandro Martínez Gallardo González

• Renoirte, Karina, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Karina Renoirte, PhD

• Navarro Blackaller, Guillermo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Navarro Blackaller, MD

• Mendoza Gaitán, Héctor Eduardo, Hospital Civil de Guadalajara, Guadalajara, Jal., Mexico

Héctor Eduardo Mendoza Gaitán, MD

• Garcia-Garcia, Guillermo, Universidad de Guadalajara, Guadalajara, Jal., Mexico

Guillermo Garcia-Garcia, MD, FASN

Background

Acute kidney injury (AKI) is a frequent and severe complication among hospitalized patients receiving intravenous (IV) colistin. Colistin-associated AKI is linked to increased morbidity and mortality; however, the determinants of risk and subsequent kidney outcomes remain incompletely characterized. This study aimed to identify factors associated with AKI during IV colistin therapy and to evaluate its relationship with major adverse kidney events (MAKE).

Methods

We conducted a retrospective cohort study at a tertiary referral center including hospitalized adults treated with IV colistin. AKI was defined according to KDIGO serum creatinine criteria. Baseline kidney function, clinical variables, infection characteristics, and outcomes were extracted from electronic health records. Multivariable logistic regression was used to identify factors independently associated with AKI, and a simplified clinical risk score was derived. MAKE, defined as death or initiation of kidney replacement therapy (KRT), was assessed at 30 and 90 days.

Results

Among 217 patients, 41.9% developed AKI. Older age (≥60 years) was independently associated with AKI (OR 1.94, 95% CI 1.03–3.57), while septic shock and baseline creatinine ≥1.5 mg/dL showed borderline associations. Microbiological profile, infection site, antimicrobial resistance, and IV colistin dose were not significantly associated with AKI. Patients who developed AKI had higher early mortality (52.7% vs. 38.9%) and a higher incidence of MAKE at 30 days (60.4% vs. 33.3%). The risk score showed a graded association with AKI, although its discriminatory performance was limited.

Conclusion

In patients receiving IV colistin, AKI was common and was primarily driven by host-related factors rather than microbiological characteristics. AKI was strongly associated with early mortality and MAKE, underscoring the importance of early risk stratification and kidney-protective strategies.