Incidence and outcomes of Colistin-induced Acute Kidney Injury in Cancer Patients with Multi-Drug Resistant Infections

Abstract

Background: Developing countries have seen a resurgence in use of colistin in recent years for treatment of multidrug resistant (MDR) gram-negative bacterial infections. Colistin is associated with increased risk of nephrotoxicity and potentially poor outcomes in high-risk patients. We studied cancer patients at our center, to analyze incidence, risk factors, and outcomes of acute kidney injury associated with use of colistin.

Methods: We reviewed patients from January 2015 until December 2018 in this single center retrospective study. Adults with solid organ or hematological malignancies with confirmed or suspected multi drug resistant gram-negative infections and received
colistin for at least 48 hours were included. Outcomes of AKI including need for renal replacement therapy (intermitting or continuous), length of stay and mortality were studied. Patients were followed up for 3-6 months following an episode of AKI
to review development of CKD. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO).
Results: A total of 115 patients who received colistin were included in this study. Mean age was 42.63 ± 15.44 years. Majority (68.7%) were male. In multivariable analysis, three independent variables including weight (adjusted odds ratio [AOR] 1.04; 95% confidence interval [CI] 1.01-1.10) underlying malignancy (solid versus hematological (AOR 3.39; 95% CI (1.15-9.98), 0.02) and need for admission to intensive care unit (ICU) (AOR 2.75; 95% CI (1.00-7.82), 0.05) were identified as significant independent risk factor for nephrotoxicity. In patients who had AKI, mean length of hospital stay was 21.7 ± 13.7 days, 20% required RRT and 10.4% developed residual CKD. Mortality was 60% in these patients.
Conclusion: Increased weight, i.e.; BMI above 25, solid organ malignancy and ICU admission were significantly associated with increased risk of AKI in this cohort. Patients who required RRT had poor outcomes with mortality of 94% in the subgroup of patients who required RRT.

Keywords: Colistin, Nephrotoxicity, Risk factors