Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria
Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria
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DOI：
10.1371/journal.pone.0173286
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发表时间：
2017-03-07
期刊：
影响因子：
3.7
通讯作者：
Bonilla, Hector
中科院分区：
文献类型：
--
作者：
Shields, Ryan K.;Anand, Rohit;Bonilla, Hector
背景急性肾损伤(AKI)仍然是粘菌素的一种治疗限制性毒性。肾脏疾病：改善全球预后(KDIGO)小组最近制定的临床实践指南统一了AKI的定义，但尚未广泛应用于接受结肠粘菌素治疗的患者。方法我们回顾了静脉注射粘菌素3天的成年患者中KDIGO定义的AKI。结果在249例服用粘菌素的患者中，48h和7d的AKI发生率分别为12%和29%。在48小时内，重症监护病房的患者患AKI的风险增加。在7天内，粘菌素每日剂量5 mg/kg、慢性肝病和合并万古霉素是独立的预测因素。7%的患者在粘菌素治疗后平均5天(范围3-7天)需要进行肾脏替代治疗。结论通过早期发现符合KDIGO标准的AKI，避免肾毒素，限制治疗时间，促进了粘菌素的安全使用。
BackgroundAcute kidney injury (AKI) remains a treatment-limiting toxicity of colistin. Recently developed clinical practice guidelines from the Kidney Disease: Improving Global Outcomes (KDIGO) group have harmonized definitions of AKI, but have not been widely applied to patients receiving colistin.MethodsWe retrospectively defined AKI by KDIGO definitions among adult patients receiving intravenous colistin for >= 3 days. Risk factors for AKI within 48 hours and 7 days of initiating colistin were determined by multivariable logistic regression.ResultsAmong 249 patients treated with colistin, rates of AKI were 12% and 29% at 48 hours and 7 days, respectively. At 48 hours, patients in the intensive care unit were at increased risk for AKI. Within 7 days, colistin daily doses >5mg/kg, chronic liver disease, and concomitant vancomycin were independent predictors. Seven percent of patients required renal replacement therapy at a median of 5 days (range: 3-7) following colistin initiation.ConclusionSafe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.