根据KDIGO标准确定黏菌素诱导的急性肾损伤的发病率和危险因素。
Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria.
作者信息
Shields Ryan K, Anand Rohit, Clarke Lloyd G, Paronish Julie A, Weirich Matthew, Perone Hanna, Kieserman Jake, Freedy Henry, Andrzejewski Christina, Bonilla Hector
机构信息
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
UPMC Mercy Hospital, Pittsburgh, Pennsylvania, United States of America.
出版信息
PLoS One. 2017 Mar 7;12(3):e0173286. doi: 10.1371/journal.pone.0173286. eCollection 2017.
BACKGROUND
Acute 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.
METHODS
We 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.
RESULTS
Among 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.
CONCLUSION
Safe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.
背景
急性肾损伤（AKI）仍然是黏菌素的一种限制治疗的毒性反应。肾脏疾病改善全球预后（KDIGO）组织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黏菌素治疗的患者。
方法
我们回顾性地根据KDIGO定义，对接受静脉注射黏菌素≥3天的成年患者中的AKI进行定义。通过多变量逻辑回归确定开始使用黏菌素后48小时和7天内AKI的危险因素。
结果
在249例接受黏菌素治疗的患者中，48小时和7天时AKI的发生率分别为12%和29%。在48小时时，重症监护病房的患者发生AKI的风险增加。在7天内，黏菌素每日剂量>5mg/kg、慢性肝病和同时使用万古霉素是独立的预测因素。7%的患者在开始使用黏菌素后的中位时间5天（范围：3 - 7天）需要进行肾脏替代治疗。
结论
通过使用KDIGO标准早期检测AKI、避免使用肾毒素以及限制治疗持续时间，可促进黏菌素的安全使用。
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