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Prevalence and risk factors for acute kidney injury associated with parenteral polymyxin B use.
Ann Pharmacother. 2009 Dec; 43(12):1948-55.AP

Abstract

BACKGROUND

The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury.

OBJECTIVE

To assess the prevalence of and risk factors for acute kidney injury (AKI) in patients treated with polymyxin B.

METHODS

The studied population included 114 patients who received at least 3 consecutive days of intravenous polymyxin B and had baseline serum creatinine (SCr) and at least one further SCr measurement during treatment. AKI was defined as an SCr increase to 1.8 mg/dL or greater in patients with baseline SCr less than 1.5 mg/dL, or an increase greater than or equal to 50% in baseline SCr when it was already greater than or equal to 1.5 mg/dL, or need for dialysis.

RESULTS

AKI developed in 22% of the patients. They were older, had a higher baseline SCr, had a higher frequency of baseline SCr greater than or equal to 1.5 mg/dL, used other nephrotoxic drugs and furosemide more often, and required vasoactive drugs and mechanical ventilation more frequently. Progression to renal failure was significantly more probable when the bacteria were isolated in the abdomen, catheter, or blood. AKI patients had a higher mortality rate (92% vs 53%; p < 0.001). Logistic regression identified abnormal baseline SCr (odds ratio [OR] 3.51); need for vasoactive drugs (OR 3.03); and abdomen, blood, or catheter as the infection site (OR 3.82) as independent risk factors for AKI.

CONCLUSIONS

Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site.

Authors+Show Affiliations

Internal Medicine Department, Division of Internal Medicine, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19887593

Citation

Mendes, Carlos A C., et al. "Prevalence and Risk Factors for Acute Kidney Injury Associated With Parenteral Polymyxin B Use." The Annals of Pharmacotherapy, vol. 43, no. 12, 2009, pp. 1948-55.
Mendes CA, Cordeiro JA, Burdmann EA. Prevalence and risk factors for acute kidney injury associated with parenteral polymyxin B use. Ann Pharmacother. 2009;43(12):1948-55.
Mendes, C. A., Cordeiro, J. A., & Burdmann, E. A. (2009). Prevalence and risk factors for acute kidney injury associated with parenteral polymyxin B use. The Annals of Pharmacotherapy, 43(12), 1948-55. https://doi.org/10.1345/aph.1M277
Mendes CA, Cordeiro JA, Burdmann EA. Prevalence and Risk Factors for Acute Kidney Injury Associated With Parenteral Polymyxin B Use. Ann Pharmacother. 2009;43(12):1948-55. PubMed PMID: 19887593.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and risk factors for acute kidney injury associated with parenteral polymyxin B use. AU - Mendes,Carlos A C, AU - Cordeiro,José A, AU - Burdmann,Emmanuel A, Y1 - 2009/11/03/ PY - 2009/11/6/entrez PY - 2009/11/6/pubmed PY - 2010/2/4/medline SP - 1948 EP - 55 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 43 IS - 12 N2 - BACKGROUND: The main adverse effect of polymyxin B is nephrotoxicity. There are few data on polymyxin-associated renal injury. OBJECTIVE: To assess the prevalence of and risk factors for acute kidney injury (AKI) in patients treated with polymyxin B. METHODS: The studied population included 114 patients who received at least 3 consecutive days of intravenous polymyxin B and had baseline serum creatinine (SCr) and at least one further SCr measurement during treatment. AKI was defined as an SCr increase to 1.8 mg/dL or greater in patients with baseline SCr less than 1.5 mg/dL, or an increase greater than or equal to 50% in baseline SCr when it was already greater than or equal to 1.5 mg/dL, or need for dialysis. RESULTS: AKI developed in 22% of the patients. They were older, had a higher baseline SCr, had a higher frequency of baseline SCr greater than or equal to 1.5 mg/dL, used other nephrotoxic drugs and furosemide more often, and required vasoactive drugs and mechanical ventilation more frequently. Progression to renal failure was significantly more probable when the bacteria were isolated in the abdomen, catheter, or blood. AKI patients had a higher mortality rate (92% vs 53%; p < 0.001). Logistic regression identified abnormal baseline SCr (odds ratio [OR] 3.51); need for vasoactive drugs (OR 3.03); and abdomen, blood, or catheter as the infection site (OR 3.82) as independent risk factors for AKI. CONCLUSIONS: Patients who developed AKI had a strikingly elevated mortality rate. Polymyxin B should be used with extreme caution in patients who have an abnormal baseline SCr; use vasoactive drugs; or have abdomen, blood, or catheter as the infection site. SN - 1542-6270 UR - https://www.unboundmedicine.com/medline/citation/19887593/Prevalence_and_risk_factors_for_acute_kidney_injury_associated_with_parenteral_polymyxin_B_use_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1M277?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -