The Effect of Different Colistin Dosing Regimens on Nephrotoxicity: A Cohort Study.
Michael Samarkos, Konstantinos Papanikolaou, Athena Sourdi, Nikolaos Paisios, Efstratios Mainas, Elisabeth Paramythiotou, Anastasia Antoniadou, Helen Sambatakou, Panayiotis Gargalianos-Kakolyris, Athanasios Skoutelis, George L Daikos
Author Information
Michael Samarkos: 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece. ORCID
Konstantinos Papanikolaou: 5th Department of Medicine, Evaggelismos Hospital, 10676 Athens, Greece.
Athena Sourdi: 1st Propaedeutic Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Nikolaos Paisios: 1st Department of Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece.
Efstratios Mainas: 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Elisabeth Paramythiotou: Intensive Care Unit, Attiko University Hospital, 12462 Athens, Greece. ORCID
Anastasia Antoniadou: 4th Department of Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece. ORCID
Helen Sambatakou: 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Panayiotis Gargalianos-Kakolyris: 1st Department of Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece.
Athanasios Skoutelis: 5th Department of Medicine, Evaggelismos Hospital, 10676 Athens, Greece.
George L Daikos: 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
(1) Background: It is not known whether different daily dosing schemes have different effects on colistin nephrotoxicity. We examined the effect of once- versus twice- or thrice-daily doses of colistin on renal function. (2) Methods: We performed a multicenter retrospective cohort study of hospitalized patients with a baseline glomerular filtration rate ≥ 50 mL/min who received intravenously the same colistin dose once (regimen A), twice (regimen B) or thrice daily (regimen C). The primary endpoint was acute kidney injury (AKI), defined as fulfilment of any of the RIFLE (Risk-Injury-Failure-Loss-End stage renal disease) criteria. (3) Results: We included 306 patients; 132 (43.1%) received regimen A, 151 (49.3%) regimen B, and 23 (7.5%) regimen C. Ninety-nine (32.4%) patients developed AKI; there was no difference between regimen A vs. B and C [45 (34.1%) vs. 54 (31.0%), p = 0.57]. In a propensity score−matched cohort, AKI was similar in patients receiving Regimen A, Regimen B, and Regimen C (31.6% vs. 33.3%, p = 0.78). On logistic regression analysis, diabetes was an independent predictor of AKI (OR = 4.59, 95% CI 2.03−10.39, p = 0.001) while eGFR > 80 mL/min (OR = 0.50, 95% CI 0.25−0.99, p = 0.048) was inversely associated with AKI. (4) Conclusions: Colistin once daily is not more nephrotoxic than the standard colistin regimens. The only independent predictor of nephrotoxicity was diabetes mellitus, while eGFR > 80 mL/min had a protective effect.
