Chronic kidney disease after acute kidney injury associated with intravenous colistin use in survivors of severe infections: A comparative cohort study

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Purpose:The use of colistin for multi-drug resistant (MDR) infections has led to an increase of colistin-associated acute kidney injury (AKI). Nevertheless, information on long-term renal prognosis is scarce. We aimed to determine the predictors of chronic kidney disease (CKD) in survivors of MDR-infections with colistin-associated AKI.Methods:A retrospective cohort of patients with colistin-associated AKI was compared with controls (survivors of severe infections who developed AKI matched by age, sex, diabetes, vancomycin exposure, and baseline kidney function). The primary outcome was the development of CKD after 6 months of follow-up.Results:From 2011 to 2015, 122 patients with MDR infections received colistin. Among 72 survivors, 29 (40%) had colistin-associated AKI. After 6 months, 22 of them (75%) progressed to CKD (G3 in 21/22) compared with 16 (27%) in 58 controls (P < 0.001). Independent predictors of progression to CKD were colistin use [odds ratio (OR): 8.86; 95% CI: 2.8–27.8] and age (OR: 1.04, 95% CI: 1.01–1.07). In patients exposed to colistin, a total dose of colistin >5 g was an independent predictor of progression to CKD (OR: 14.1, 95% CI: 2.6–75.7).Conclusion:Colistin-associated AKI had a substantial risk for the latter development CKD, and consequently, these patients should be tightly monitored.HighlightsColistin-associated AKI in survivors of multi-drug resistant infections is mild yet it is associated with permanent kidney damage.They should be tightly monitored when AKI is identified. Patients with the higher risk were elderly and those exposed to colistin.

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