ABSTRACT
The study aimed to prospectively assess incidence and risk factors for colistin-associated nephrotoxicity. This is a secondary analysis of a multicentre, randomized clinical trial, comparing efficacy and safety of colistin versus the combination of colistin plus rifampicin in severe infections due to extensively drug-resistant (XDR) Acinetobacter baumannii. The primary end point was acute kidney injury (AKI) during colistin treatment, assessed using the AKI Network Criteria, and considering death as a competing risk. A total of 166 adult patients without baseline kidney disease on renal replacement therapy were studied. All had life-threatening infections due to colistin-susceptible XDR A. baumannii. Patients received colistin intravenously at the same initial dose (2 million international units (MIU) every 8 h) with predefined dose adjustments according to the actual renal function. Serum creatinine was measured at baseline and at days 4, 7, 11, 14 and 21 (or last day of therapy when discontinued earlier). Outcomes assessed were 'time to any kidney injury' (AKI stages 1-3) and 'time to severe kidney injury' (considering only AKI stages 2-3 as events). When evaluating overall mortality, AKI occurrence was modelled as a time-dependent variable. AKI was observed in 84 patients (50.6%, stage 1 in 40.4%), with an incidence rate of 5/100 person-days (95% CI 4-6.2). Risk estimates of AKI at 7 and 14 days were 30.6% and 58.8%. Age and previous chronic kidney disease were significantly associated with any AKI in multivariable analysis. Neither 'any' nor 'severe AKI' were associated with on-treatment mortality (p 0.32 and p 0.54, respectively). AKI occurs in one-third to one-half of colistin-treated patients and is more likely in elderly patients and in patients with kidney disease. As no impact of colistin-associated AKI on mortality was found, this adverse event should not represent a reason for withholding colistin therapy, whenever indicated.
Subject(s)
Acinetobacter Infections/drug therapy , Acute Kidney Injury/chemically induced , Acute Kidney Injury/epidemiology , Anti-Bacterial Agents/adverse effects , Colistin/adverse effects , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/drug effects , Adult , Aged , Anti-Bacterial Agents/administration & dosage , Colistin/administration & dosage , Creatinine/blood , Dose-Response Relationship, Drug , Endpoint Determination , Female , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Rifampin/administration & dosage , Rifampin/adverse effects , Risk AssessmentABSTRACT
Extracorporeal dialysis in uremic subjects produces erythrocyte alterations on energetic and redox metabolism. On this basis, we have tried to verify a fundamental parameter for the integrity of the red blood cell namely the glutathione content both in the oxidized and reduced form. Comparisons were made between two groups of subjects (similar in age, sex and number). One group consisted of uremic subjects undergoing dialysis and the other in healthy controls. As well as a slight increase in reduced glutathione (GSH), an accumulation of oxidized glutathione (GSSG) was found which, in postdialysis patients, reached values up to 3 times higher than in controls. This means a lowering in the ratio GSH/GSSG. There was also a decrease in total Mg(++)-ATPase activity, significantly found in erythrocyte ghosts of postdialysis patients. The hypothesis of a reduced efflux of GSSG as well as an increase in its formation speed (activation of glutathione peroxidase) is taken into consideration.
