title: Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria.
abstract: 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.
  
  
  CONCLUSIONS
  Safe use of colistin is promoted by early detection of AKI with KDIGO criteria, avoiding nephrotoxins, and limiting duration of therapy.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Shields
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Rohit
authors.initials: R
authors.lastname: Anand
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Lloyd G
authors.initials: LG
authors.lastname: Clarke
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Paronish
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Matthew
authors.initials: M
authors.lastname: Weirich
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Hanna
authors.initials: H
authors.lastname: Perone
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Jake
authors.initials: J
authors.lastname: Kieserman
authors.affiliation: UPMC Mercy Hospital, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Henry
authors.initials: H
authors.lastname: Freedy
authors.affiliation: UPMC Mercy Hospital, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Christina
authors.initials: C
authors.lastname: Andrzejewski
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.|UPMC Mercy Hospital, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Hector
authors.initials: H
authors.lastname: Bonilla
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D003091:Colistin / Q000009:adverse effects*; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin