Risk Factors for Acute Kidney Injury in Patients Treated with Polymyxin B: Experience from 139 Cases at a Tertiary University Hospital in Colombia

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

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Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2013.12.002 ◽

2014 ◽

Vol 43 (4) ◽

pp. 349-352 ◽

Cited By ~ 72

Author(s):

Felipe F. Tuon ◽

Maria Helena Rigatto ◽

Cesar K. Lopes ◽

Letícia K. Kamei ◽

Jaime L. Rocha ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Polymyxin B ◽

Colistin Methanesulfonate

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To study the clinical efficacy and nephrotoxicity along with the risk factors for acute kidney injury associated with parenteral polymyxin B

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.120319 ◽

2013 ◽

Vol 17 (5) ◽

pp. 283-287 ◽

Cited By ~ 7

Author(s):

Amit Kumar Mandal ◽

Ruchika Nandha ◽

Kavita Sekhri

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Clinical Efficacy ◽

Kidney Injury ◽

Polymyxin B

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Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity

Antibiotics ◽

10.3390/antibiotics8010024 ◽

2019 ◽

Vol 8 (1) ◽

pp. 24 ◽

Cited By ~ 16

Author(s):

Roger Nation ◽

Maria Rigatto ◽

Diego Falci ◽

Alexandre Zavascki

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Injury ◽

Polymyxin B ◽

Multidrug Resistant ◽

Therapeutic Window ◽

Common Side Effect ◽

Dose Selection ◽

Dosing Strategies ◽

Risk Patients

Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies.

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Risk Factors and Outcomes of Acute Kidney Injury in Neonates with Persistent Pulmonary Hypertension of the Newborn

Medeniyet Medical Journal ◽

10.5222/mmj.2021.22687 ◽

2021 ◽

Author(s):

Nuran Üstün ◽

Fahri Ovalı

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Pulmonary Hypertension ◽

Neonatal Intensive Care ◽

Kidney Injury ◽

University Hospital ◽

Persistent Pulmonary Hypertension ◽

Increased Risk ◽

Stage 1

Objective: To identify the incidence of and risk factors for acute kidney injury (AKI) in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to evaluate its association with neonatal outcomes. Method: A total of 78 newborns with confirmed PPHN admitted to the neonatal intensive care unit of a university hospital between 2016 and 2020 were retrospectively analyzed. AKI was defined according to the modified neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of 78 PPHN infants, AKI was found in 29.5% (23/78). Multivariate analysis indicated that male sex (OR 3.43 95% CI 1.03-11.48, p=0.04) and severe PPHN (OR 5.67 95% CI 1.55- 20.68, p<0.01) were independently associated with increased risk for AKI. Infants with AKI had significantly higher mortality rate than infants without AKI (43.5% vs. 9.1%, p<0.01). Mortality rates in stage 1, stage 2 and stage 3 AKI were similar (36.4%, 57.1%, and 40%, respectively, p=0.68). Among survivors, AKI infants had significantly longer mechanical ventilation and lenght of stay than infants without AKI. Conclusion: In infants with PPHN, AKI is a common complication and is associated with increased mortality, and longer mechanical ventilation and lenght of stay. Careful monitoring of kidney function in infants with PPHN, especially in males and those who had severe PPHN can help to improve patient outcomes.

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Risk factors for acute kidney injury in patients treated with polymyxin B at a Tertiary Care Medical Center

Brazilian Journal of Nephrology ◽

10.5935/0101-2800.20150071 ◽

2015 ◽

Vol 37 (4) ◽

Cited By ~ 5

Author(s):

Laura Fuchs Bahlis ◽

Luciano Passamani Diogo ◽

Daniel Lemons ◽

Denise Klaus

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Medical Center ◽

Tertiary Care ◽

Kidney Injury ◽

Polymyxin B ◽

Tertiary Care Medical Center

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Acute Kidney Injury in COVID-19: 90 Days of the Pandemic in a Brazilian Public Hospital

Frontiers in Medicine ◽

10.3389/fmed.2021.622577 ◽

2021 ◽

Vol 8 ◽

Cited By ~ 1

Author(s):

Welder Zamoner ◽

Camilla Andrade da Silva Santos ◽

Luís Eduardo Magalhães ◽

Paula Gabriela Sousa de Oliveira ◽

André Luis Balbi ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Severe Disease ◽

Renal Involvement ◽

Kidney Injury ◽

Apache Ii ◽

University Hospital ◽

Apache Ii Score ◽

Disease Manifestation ◽

Factors Associated

Renal involvement is frequent in COVID-19 (4–37%). This study evaluated the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients with COVID-19.Methodology: This study represents a prospective cohort in a public and tertiary university hospital in São Paulo, Brazil, during the first 90 days of the COVID-19 pandemic, with patients followed up until the clinical outcome (discharge or death).Results: There were 101 patients hospitalized with COVID-19, of which 51.9% were admitted to the intensive care unit (ICU). The overall AKI incidence was 50%; 36.8% had hematuria or proteinuria (66.6% of those with AKI), 10.2% had rhabdomyolysis, and mortality was 36.6%. Of the ICU patients, AKI occurred in 77.3% and the mortality was 65.4%. The mean time for the AKI diagnosis was 6 ± 2 days, and Kidney Disease Improving Global Outcomes (KDIGO) stage 3 AKI was the most frequent (58.9%). Acute renal replacement therapy was indicated in 61.5% of patients. The factors associated with AKI were obesity [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.04–2.76, p < 0.05] and the APACHE II score (OR 1.97, 95% CI 1.08–2.64, p < 0.05). Mortality was higher in the elderly (OR 1.03, 95% CI 1.01–1.66, p < 0.05), in those with the highest APACHE II score (OR 1.08, 95% CI 1.02–1.98, p < 0.05), and in the presence of KDIGO stage 3 AKI (OR 1.11, 95% CI 1.05–2.57, p < 0.05).Conclusion: AKI associated with severe COVID-19 in this Brazilian cohort was more frequent than Chinese, European, and North American data, and the risk factors associated with its development were obesity and higher APACHE II scores. Mortality was high, mainly in elderly patients, in those with a more severe disease manifestation, and in those who developed KDIGO stage 3 AKI.

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Acute kidney injury: Incidence, risk factors, and outcomes in severe COVID-19 patients

PLoS ONE ◽

10.1371/journal.pone.0251048 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251048

Author(s):

Danilo Candido de Almeida ◽

Maria do Carmo Pinho Franco ◽

Davi Rettori Pardo dos Santos ◽

Marina Colella Santos ◽

Isabela Soucin Maltoni ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Univariate Analysis ◽

Kidney Injury ◽

University Hospital ◽

Injury Incidence ◽

Vasoactive Drugs ◽

Reactive Protein ◽

Incidence Risk ◽

Potential Risk Factors

Background COVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear. Methods We performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed. Results First, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge. Conclusions In our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.

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