Pharmaceutical Care Service, Ministry of the National Guard - Health Affairs; King Abdullah International Medical Research Center; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Saud bin Abdulaziz University for Health Sciences; Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Saudi J Kidney Dis Transpl. 2020 Sep-Oct;31(5):1057-1061. doi: 10.4103/1319-2442.301171.
Colistin-induced nephrotoxicity is a well-known major adverse event, which may occur within seven days [early acute kidney injury (AKI)] with a high mortality rate of 70% or after seven days (late AKI). The main objective of this retrospective study is to assess the severity and associated risk factors for the development of colistin-related nephrotoxicity. An observational retrospective cohort study was conducted over 12 months (January-December 2017). All patients with a baseline normal renal function, who received intravenous colistin for >72 h, were included. Nephrotoxicity was defined using the RIFLE criteria (Risk, Injury, Failure, Loss, and End-stage renal disease). The demographic and clinical variables were retrieved from the hospital's electronic medical record system and compiled in an electronic database. All the statistical analysis was carried out by SAS JMP from SAS Institute Inc., Cary, NC. Seventy patients met the inclusion criteria. Colistin-induced nephrotoxicity occurred in 45.71% of the patients, of whom 40.6% were at Risk, 21.9% at Injury, and 37.5% at Failure according to RIFLE criteria. In patients who developed AKI, the average total colistin dose received before AKI was 4.4 mg/kg/day. More than half of the AKI group (53.13%) received an inappropriate total dose of colistin. Age, 65 years and older, was significantly associated with a high risk of nephrotoxicity (P <0.05), which developed within 6.8 ± 0.44 days from receiving a colistin dose. Clinical pharmacy services were consulted in 28.13% of the cases, and the dose was adjusted in 37.5% of the patients. Colistin nephrotoxicity is common and is associated more with older age group and inappropriate dosing.
黏菌素相关性肾毒性是一种众所周知的主要不良事件，可能在 7 天内发生（早期急性肾损伤[AKI]），死亡率高达 70%，也可能在 7 天后发生（晚期 AKI）。本回顾性研究的主要目的是评估黏菌素相关性肾毒性的严重程度和相关危险因素。一项为期 12 个月（2017 年 1 月至 12 月）的回顾性观察队列研究。所有基线肾功能正常、接受静脉黏菌素治疗超过 72 小时的患者均纳入研究。采用 RIFLE 标准（风险、损伤、衰竭、丧失和终末期肾病）定义肾毒性。从医院的电子病历系统中检索人口统计学和临床变量，并在电子数据库中进行编译。所有统计分析均由 SAS Institute Inc.的 SAS JMP 完成。符合纳入标准的患者共 70 例。45.71%的患者发生黏菌素相关性肾毒性，其中 40.6%为风险，21.9%为损伤，37.5%为衰竭。在发生 AKI 的患者中，发生 AKI 前平均总黏菌素剂量为 4.4mg/kg/d。超过一半的 AKI 组（53.13%）接受了不适当的总黏菌素剂量。65 岁及以上的患者年龄与肾毒性风险显著相关（P<0.05），在接受黏菌素剂量后 6.8±0.44 天内发生。28.13%的病例咨询了临床药学服务，37.5%的患者调整了剂量。黏菌素相关性肾毒性很常见，与年龄较大的患者群体和不适当的剂量有关。
