Colistin Nephrotoxicity-Age and Baseline kidney Functions Hold the Key.

INTRODUCTION

With the emergence of multidrug-resistant gram-negative bacterial infections, there has been a surge in the use of Colistin in recent times. The most important side effect of Colistin use is its nephrotoxicity. The study was designed to assess the effect on kidney function and the risk factors for nephrotoxicity in patients treated with Colistin.

METHODS

The study is a retrospective one, which included patients who received Colistin for more than 48 hours. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) four-variable equation and acute kidney injury (AKI) was diagnosed as per the Kidney Disease Improving Global Outcome (KDIGO) criteria.

RESULTS

Of the 150 patients studied, 59 patients (39.2%) developed AKI within a median period of 4 days (Range 2-20 days) of initiation of Colistin. Age, eGFR at the start of therapy and requirement of vasopressor support for treatment of septic shock were the most important risk factors associated with nephrotoxicity. Among patients with AKI, nearly half had only mild worsening of renal functions to KDIGO AKI stage 1. Nearly 75% of patients with AKI had complete or partial recovery of renal functions after stopping Colistin.

CONCLUSION

Colistin has significant nephrotoxicity, the risk being higher with older age and baseline renal dysfunction. It is important to monitor renal functions early and at regular intervals after initiating therapy.