Incidence and risk factors of nephrotoxicity associated with intravenous colistin use in the intensive care unit

Abstract

Background/Aim: The most serious side effect of colistin therapy is nephrotoxicity. This study aimed to investigate the incidence of nephrotoxicity (NT) due to intravenous colistin and determine the associated risk factors in critically ill patients in the intensive care unit (ICU). Methods: This retrospective cohort study was conducted by examining the files of 100 patients who were hospitalized in the ICU and received intravenous colistin therapy. According to the RIFLE criteria, the patients were divided into two groups as those with and without nephrotoxicity. The clinical characteristics of the patients were compared between the groups and the risk factors associated with nephrotoxicity were determined by multivariate linear logistic regression analysis. Results: The mean age, mean length of stay in the ICU, and mortality rate of 44 patients included in the study were 68±16.36 years, 77.14 (83.03) days, and 56.8%, respectively. NT developed in 22 (50%) patients during colistin therapy. In those with NT, diabetes mellitus, chronic obstructive pulmonary disease, and coronary artery disease were significantly more common (P<0.05 for all), the mean age (P<0.001), Charlson age-adjusted comorbidity index (CACI) scores, APACHE scores (P=0.010) were higher and albumin level was lower (P=0.001). High CACI scores (B=0.532, P=0.002) and low albumin levels (B=-0.323, P=0.023) were significant risk factors for colistin NT according to the regression analysis. Conclusion: Nephrotoxicity is significantly common among critically ill patients receiving colistin therapy. Patients with high CACI scores and hypoalbuminemia should be followed up closely for nephrotoxicity.