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Colistin-associated AKI, attributable risk and time course
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Colistin is typically associated with substantial excess acute kidney injury that is apparent within 72 hours of treatment; however, colistin’s toxicity varied according to baseline hemoglobin concentration, according to recent findings published in the Clinical Journal of the American Society of Nephrology.
Noting whether substantial toxicity occurs during the initial 72 hours of exposure is critical for early treatment decisions. Because the attributable risk and timing of toxicity onset are still unknown, researchers within the University of Pennsylvania Health System compared colistin-exposed patients (n = 150) with a matched control group given other antibiotics from May 1, 2008, to September 20, 2014.
The investigators reported using colistimethate sodium with each vial containing 150 mg of colistin base activity. Dosing followed the package insert recommendation of 2.5 mg/kg to 5 mg/kg per day colistin base activity divided into two to three doses for patients with normal kidney function.
According to the investigators, the cumulative incidence of AKI at the end of follow-up was 51% in the colistin group vs. 22% in matched controls. They also reported a higher risk difference at 72 hours: 20% in the colistin group vs. 11% in the control group.
Further, the investigators noted that the incidence of AKI in the colistin courses in their study was 51% consistent with several recent studies showing incidence rates between 40% to 53%, and results that suggest low toxicity risk were from studies with more restrictive AKI definitions and less aggressive dosing regimens.
Colistin has been available for decades, and while its use has declined due to its relationship with nephrotoxicity, its propensity to cause nephrotoxicity has caused substantial confusion. However, the onset of toxicity seems to be rapid and is consistent with colistin’s high intrinsic toxicity and extensive accumulation in the cortical tissue of the kidney. – by Jake Scott
Disclosure: The authors report no relevant financial disclosures.
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