Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy

Kubin, Christine J.; Ellman, Tanya M.; Phadke, Varun; Haynes, Laura J.; Calfee, David P.; Yin, Michael T.

doi:10.1016/j.jinf.2012.01.015

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Article in Press

Incidence and predictors of acute kidney injury associated with intravenous polymyxin B therapy

Christine J. Kubin
- Department of Pharmacy, New York-Presbyterian Hospital, 630 W. 168th Street, New York, NY 10032, USA
- Department of Medicine, Columbia University College of Physicians & Surgeons, 630 W. 168th Street, New York, NY 10032, USA
- Corresponding author. Department of Medicine, Columbia University College of Physicians & Surgeons, 630 W. 168th Street, New York, NY 10032, USA. Tel.: +1 212 305 0610; fax: +1 212 342 2957.
Tanya M. Ellman
- Department of Medicine, Columbia University College of Physicians & Surgeons, 630 W. 168th Street, New York, NY 10032, USA
Varun Phadke
- Department of Medicine, Columbia University College of Physicians & Surgeons, 630 W. 168th Street, New York, NY 10032, USA
Laura J. Haynes
- Department of Pharmacy, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
- At time of research, affiliation: Department of Pharmacy, New York-Presbyterian Hospital, 622 W 168th St, New York, NY 10032.
David P. Calfee
- Department of Medicine and Public Health, Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
Michael T. Yin
- Department of Medicine, Columbia University College of Physicians & Surgeons, 630 W. 168th Street, New York, NY 10032, USA

Accepted 27 January 2012. published online 06 February 2012.
Corrected Proof

Summary

Background

Increases in multidrug-resistance among gram-negative organisms have necessitated the use of polymyxins. To date, the incidence of acute kidney injury (AKI) associated with polymyxin B has not been evaluated using RIFLE criteria.

Methods

Adult patients who received polymyxin B were retrospectively evaluated to determine the incidence of AKI during polymyxin B therapy using RIFLE criteria. Predictors of AKI were identified by comparing characteristics of patients with and without AKI.

Results

A total of 73 patients were included. The incidence of AKI was 60%. Ten (14%) patients discontinued therapy due to nephrotoxicity. Median duration of polymyxin B was 11 days with a median cumulative dose of 18 mg/kg. Concomitant nephrotoxins were received in 69 (95%). Patients with AKI had a higher median cumulative dose (1578 mg vs. 800 mg; p = 0.02), a higher body mass index (BMI) (27.2 vs. 24.5 kg/m²; p = 0.03), and were more likely to receive vancomycin (82% vs. 55%; p = 0.03) compared to those without AKI. After controlling for polymyxin B duration, independent predictors of AKI were higher BMI and concomitant vancomycin.

Conclusions

The incidence of AKI during polymyxin B therapy was 60%. Further studies are needed to define dosing parameters that maximize efficacy and minimize nephrotoxicity.

Keywords: Polymyxin B, Nephrotoxicity, RIFLE