Table 1. Factors associated with colistin-induced Acute Kidney Injury (AKI).
| Variable | All patients (n = 249) | AKI at 48 hours (≥ 0.3 mg/dL increase in SCr) | AKI within 7 days (≥ 1.5x baseline SCr) | ||||||
|---|---|---|---|---|---|---|---|---|---|
| AKI | No AKI | Univariate | Multivariate | AKI | No AKI | Univariate | Multivariate | ||
| (n = 30) | (n = 219) | P-value | P-value (OR, 95% CI) | (n = 73) | (n = 176) | P-value | P-value (OR, 95% CI) | ||
| Median age (range), years | 59 (18–91) | 63 (41–77) | 59 (18–91) | 0.151 | 62 (23–81) | 57.5 (18–91) | 0.034 | 0.138 | |
| Male sex, no. (%) | 132 (53) | 18 (60) | 114 (52) | 0.414 | 45 (62) | 87 (49) | 0.079 | 0.347 | |
| Caucasian, no. (%) | 198 (80) | 21 (70) | 177 (81) | 0.168 | 58 (79) | 140 (80) | 0.987 | ||
| Comorbidities, no. (%) | |||||||||
| • Chronic respiratory disease | 114 (46) | 10 (33) | 104 (47) | 0.206 | 30 (41) | 84 (48) | 0.414 | ||
| • Congestive heart failure | 105 (42) | 11 (28) | 94 (43) | 0.650 | 34 (47) | 71 (40) | 0.444 | ||
| • Chronic kidney disease | 33 (13) | 3 (10) | 30 (14) | 0.575 | 9 (12) | 24 (14) | 0.782 | ||
| • Chronic liver disease | 29 (12) | 6 (20) | 23 (11) | 0.134 | 14 (19) | 15 (9) | 0.028 | 0.011 (3.09, 1.30–7.34) | |
| • Diabetes mellitus | 77 (31) | 8 (27) | 69 (32) | 0.591 | 21 (29) | 56 (32) | 0.655 | ||
| • Obesity (BMI >30) | 8 (3) | 1 (3) | 7 (32) | 0.968 | 3 (4) | 5 (3) | 0.696 | ||
| Median Charlson Score (range) | 4 (0–11) | 3 (0–8) | 4 (0–11) | 0.353 | 4 (0–10) | 3 (0–11) | 0.537 | ||
| Solid-organ transplant recipient, no. (%) | 46 (18) | 7 (23) | 39 (18) | 0.465 | 17 (23) | 29 (16) | 0.207 | ||
| Intensive care unit at start of therapy, no. (%) | 160 (64) | 26 (87) | 134 (61) | 0.007 | 0.024 (3.57, 1.18–10.8) | 52 (71) | 108 (61) | 0.139 | |
| Requirement for vasopressors, no. (%) | 89 (36) | 14 (47) | 75 (34) | 0.183 | 29 (40) | 60 (34) | 0.398 | ||
| Serum albumin < 2 g/dL, no. (%) | 92 (37) | 10 (33) | 82 (37) | 0.662 | 28 (38) | 64 (36) | 0.767 | ||
| Median baseline SCr (range) | 0.8 (0.1–3.7) | 1.1 (0.4–2.9) | 0.8 (0.1–3.7) | 0.006 | 0.115 | 1.0 (0.2–3.6) | 0.8 (0.1–3.7) | 0.003 | 0.094 |
| Median colistin dose in mg/kg/day (range)* | 3.45 (0.5–7.69) | 3.49 (1.18–6.06) | 3.44 (0.5–7.69) | 0.751 | 3.45 (0.85–7.69) | 3.48 (0.5–6.56) | 0.802 | ||
| Colistin dose > 5mg/kg/day, no. (%) | 37 (15) | 6 (20) | 31 (14) | 0.413 | 16 (22) | 21 (12) | 0.044 | 0.017 (2.58, 1.18–5.61) | |
| Colistin loading dose, no. (%) | 118 (47) | 17 (57) | 101 (46) | 0.278 | 42 (58) | 76 (43) | 0.039 | 0.284 | |
| Concomitant inhaled colistin, no. (%) | 60 (24) | 6 (20) | 54 (25) | 0.656 | 19 (26) | 41 (23) | 0.630 | ||
| Concomitant nephrotoxins, no. (%) | |||||||||
| • Intravenous contrast dye | 36 (14) | 3 (10) | 33 (15) | 0.588 | 7 (10) | 29 (16) | 0.159 | ||
| • Aminoglycoside | 60 (24) | 8 (27) | 52 (24) | 0.726 | 19 (26) | 41 (23) | 0.646 | ||
| • Vancomycin | 140 (56) | 21 (70) | 119 (54) | 0.105 | 50 (68) | 90 (51) | 0.012 | 0.03 (1.98, 1.07–3.66) | |
| • Amphotericin B | 13 (5) | 4 (13) | 9 (4) | 0.057 | 0.088 | 5 (7) | 8 (5) | 0.533 | |
| • Calcineurin inhibitor | 45 (18) | 7 (23) | 38 (17) | 0.425 | 17 (23) | 28 (16) | 0.168 | ||
| • Angiotensin converting enzyme inhibitor | 12 (5) | 0 (0) | 12 (5) | 0.370 | 1 (1) | 11 (6) | 0.189 | ||
| • Loop diuretic | 112 (45) | 13 (43) | 99 (45) | 0.847 | 39 (53) | 73 (41) | 0.085 | 0.151 | |
| • NSAID | 44 (18) | 2 (7) | 42 (19) | 0.125 | 11 (15) | 33 (19) | 0.488 | ||
| Concomitant antibiotics, no. (%) | |||||||||
| • Penicillin | 83 (33) | 15 (50) | 68 (31) | 0.061 | 0.075 | 24 (33) | 59 (34) | 0.922 | |
| • Cephalosporin | 64 (26) | 8 (27) | 56 (26) | 0.898 | 21 (29) | 43 (24) | 0.476 | ||
| • Carbapenem | 184 (74) | 22 (73) | 162 (74) | 0.940 | 56 (77) | 128 (73) | 0.515 | ||
| • Fluoroquinolone | 41 (16) | 3 (10) | 38 (17) | 0.433 | 11 (15) | 30 (17) | 0.702 | ||
| • Tetracycline | 37 (15) | 5 (17) | 32 (15) | 0.785 | 9 (12) | 28 (16) | 0.470 | ||
| • Macrolide | 31 (12) | 2 (7) | 29 (13) | 0.391 | 5 (7) | 26 (15) | 0.095 | ||
AKI = Acute kidney injury, BMI = Body mass index, NSAID = Non-steroidal anti-inflammatory drug, SCr = Serum creatinine
* Defined as the average daily dose administered over the first 72 hours of colistin therapy divided by total body weight.