title: Clinical features and mortality of patients on renal replacement therapy receiving polymyxin B.
abstract: There are no clinical data for polymyxin B (PMB) in patients on renal replacement therapy (RRT). The aim of this study was to evaluate the characteristics of patients on RRT receiving PMB and to identify predictors of 30-day mortality, with special focus on dosage. A multicentre prospective cohort study including patients aged ≥18 years treated with PMB for ≥48h while on any type of RRT was performed. In total, 88 patients were evaluated, including 34 (38.6%) on continuous venovenous haemodialysis (CVVH) and 54 (61.4%) on intermittent haemodialysis. Most patients (81.8%) received recommended doses between 1.5mg/kg/day and 3.0mg/kg/day. The 30-day mortality was 51.1% (45/88 patients). There was no significant association of dose (in mg/kg) with mortality. A PMB average daily dose ≥200mg was predictive of decreased 30-day mortality in the multivariate model (hazard ratio=0.35, 95% confidence interval 0.14-0.90; P=0.03), whilst CVVH (P=0.04), higher Charlson co-morbidity index (P=0.02) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (P=0.04), and Pseudomonas aeruginosa infection (P=0.001) were independent risk factors for mortality. The results were not changed by the inclusion of patient weight or dose (in mg/kg) in the model, although the latter was significantly correlated with total daily dose. This is the first clinical study to show that higher doses of PMB are associated with lower mortality in patients on RRT.
authors.affiliation: Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil.
authors.forename: Maria Helena
authors.initials: MH
authors.lastname: Rigatto
authors.affiliation: Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil; Infection Control Service, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
authors.forename: Diego R
authors.initials: DR
authors.lastname: Falci
authors.affiliation: Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Natane T
authors.initials: NT
authors.lastname: Lopes
authors.affiliation: Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil; Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address: azavascki@hcpa.edu.br.
authors.forename: Alexandre P
authors.initials: AP
authors.lastname: Zavascki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications*; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B
keywords: Dose; Haemodialysis; Mortality; Polymyxin B