Variables determining the development of colistin-associated renal impairment.
OBJECTIVE
The aim of this study was to identify the predictors of acute renal injury associated with colistin treatment.


METHODS
The patients who received treatment with colistin for more than 3 days were included in this retrospective cohort study. Acute renal injury was defined by the RIFLE (Risk Injury Failure Loss End stage renal disease) criteria. Patients whose serum creatinine levels increased at least 1.5-fold compared with baseline value were considered as cases with renal injury. The independent variables determining the development of acute renal injury were investigated by survival analysis.


RESULTS
A total of 112 cases [67 (59.8 %) were male, median age 64 (range: 18-93) years] were included in the study. Acute renal injury occurred in 66 (58.9 %) patients. Renal injury developed in first 7 days of the colistin therapy in 52 (78.8 %) cases and at day 8-23 in 14 (21.2 %) cases. On the day with highest levels of creatinine, 25 (22.3 %), 17 (15.2 %), and 33 (29.5 %) cases were in 'Risk', 'Injury', and 'Failure' group, respectively, according to RIFLE criteria. We identified three independent risk factors predicting acute colistin-induced renal injury: advanced age, low serum albumin levels, and high serum total bilirubin levels [odds ratio (confidence interval) = 1.022 (1.006-1.037), 0.643 (0.415-0.994), and 1.129 (1.014-1.257), respectively].


CONCLUSIONS
The advanced age, low serum albumin levels, and high serum total bilirubin levels are independent risk factors for colistin-induced nephrotoxicity.
Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakıf University, Vatan Caddesi, Fatih, Istanbul, Turkey. bceylan2004@yahoo.com.|Yıldırım Beyazıt Caddesi, Bosnapark Evleri, No: 8, Daire 13, Kat 3, Zafer Mahallesi, Yenibosna, Bahçelievler, Istanbul, Turkey. bceylan2004@yahoo.com.
Bahadır
B
Ceylan
Department of Infectious, Diseases and Clinical Microbiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Müdür
M
Taniş
Faculty of Medicine, Department of Thoracic Diseases, Bezmialem Vakıf University, Istanbul, Turkey.
Muhammed Emin
ME
Akkoyunlu
Faculty of Medicine, Department of Internal Medicine, Bezmialem Vakıf University, Istanbul, Turkey.
Ahmet
A
Çınar
Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakıf University, Vatan Caddesi, Fatih, Istanbul, Turkey.
Ayşe Ruhkar
AR
Kurt
Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakıf University, Vatan Caddesi, Fatih, Istanbul, Turkey.
Yasemin
Y
Akkoyunlu
Faculty of Medicine, Department of Thoracic Diseases, Bezmialem Vakıf University, Istanbul, Turkey.
Didem
D
Ozkan
Faculty of Medicine, Department of Thoracic Diseases, Bezmialem Vakıf University, Istanbul, Turkey.
Hatice Kutbay
HK
Ozcelik
Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bezmialem Vakıf University, Vatan Caddesi, Fatih, Istanbul, Turkey.
Turan
T
Aslan
Department of Infectious, Diseases and Clinical Microbiology, Istanbul Training and Research Hospital, Istanbul, Turkey.
Muzaffer
M
Fincancı
Department of Anesthesiology and Reanimation, Istanbul Training and Research Hospital, Istanbul, Turkey.
Şule
Ş
Vatansever
Faculty of Medicine, Department of Anesthesiology and Reanimation, Bezmialem Vakıf University, Istanbul, Turkey.
Kadir
K
İdin
Faculty of Medicine, Department of Anesthesiology and Reanimation, Bezmialem Vakıf University, Istanbul, Turkey.
Emine
E
Guler
Faculty of Medicine, Department of Anesthesiology and Reanimation, Bezmialem Vakıf University, Istanbul, Turkey.
Harun
H
Uysal
D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003091:Colistin / Q000009:adverse effects* / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
D015415:Biomarkers; D003404:Creatinine; D003091:Colistin
Acute renal injury; Adverse effects; Colistin; Drug-induced abnormalities; Renal tubulopathy