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Aug 5, 2016 - characteristics of intravenous (IV) or inhaled (IH) colistin-associated acute kidney injury (AKI) using the Risk, Injury, Failure, Loss, End-stage ...

Accepted Manuscript Comparison of clinical characteristics of patients with acute kidney injury after intravenous versus inhaled colistin therapy A Young Cho, Hyun Ju Yoon, Jung Cheol Lee, Jin Young Kwak, Kwang Young Lee, In O. Sun, MD PII:

S2211-9132(16)30019-5

DOI:

10.1016/j.krcp.2016.07.005

Reference:

KRCP 272

To appear in:

Kidney Research and Clinical Practice

Received Date: 5 March 2016 Revised Date:

27 June 2016

Accepted Date: 20 July 2016

Please cite this article as: Cho AY, Yoon HJ, Lee JC, Kwak JY, Lee KY, Sun IO, Comparison of clinical characteristics of patients with acute kidney injury after intravenous versus inhaled colistin therapy, Kidney Research and Clinical Practice (2016), doi: 10.1016/j.krcp.2016.07.005. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT

Comparison of clinical characteristics of patients with acute kidney injury after intravenous versus inhaled colistin therapy

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A Young Cho1, Hyun Ju Yoon1, Jung Cheol Lee2, Jin Young Kwak2, Kwang Young Lee1, In O Sun1

Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center,

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1

Jeonju, Korea

Division of Pulmonary, Department of Internal Medicine, Presbyterian Medical Center,

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2

Jeonju, Korea

Running title: Colistin-induced acute kidney injury

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Corresponding author: In O Sun, MD

Department of Internal Medicine, Presbyterian Medical center, 300 Junghwasan-Dong,

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Wansan-Ku, Jeonju, Korea

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Fax: +82-2-230-1339, Phone: +82-2-230-1332 E-mail: [email protected]

Abstract

Background: The aim of this study is to investigate the incidence and clinical characteristics of intravenous or inhaled colistin associated acute kidney injury (AKI) using the RIFLE 1

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criteria. Methods: From 2010 to 2014, 160 patients were treated with intravenous or inhaled colistin. Of these, we included 126 patients who received colistin for >72 h for the treatment of

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pneumonia, and compared the incidence and clinical characteristics of patients in the intravenous (n=107) and inhaled (n=19) groups.

Results: The patients included 104 men and 22 women, with a mean age of

69 years (range,

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24-91). The mortality rate was 45%, and AKI occurred in 75 (60%) patients. At the end of therapy, bacteriologic cure rate was 66%. There were no differences in the clinical

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characteristics between the intravenous and inhaled groups except for age. In comparison with patients in the intravenous group, the patients in the inhaled group were older (74 ± 8 vs 68± 12 years, p=0.026). The incidence of AKI was not different between the two groups (62% vs 47%, p=NS), and there was no difference in the severity of AKI according to the

therapy, respectively.

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RIFLE criteria. Of the 83 patients with AKI, 6 and 1 patients underwent renal replacement

Conclusion: The incidence of AKI in patient with colistin therapy is 60% in our center. It seems that inhaled colistin therapy could not be better in safety than intravenous colistin

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therapy.

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Key words: acute kidney injury, colistin, intravenous, inhaler

Introduction

Colistin is an antibiotic that was used until the early 1980s to treat infections caused by gram-negative rods [1,2]. When gentamicin and second and third-generation 2

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cephalosporins became available, however, colistin fell out of favor due to the reported high incidence of nephrotoxicity [1-3]. However, the emergence of multi-drug resistant gramnegative bacteria such as Pseudomonas aeruginosa and Acinetobacter baumanni resulted in

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reconsideration of the use of intravenous colistin as a last resort for treatment of these infections [1,3, 4].

Inhaled colistin has been successfully used to prevent and cure pulmonary

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infections in cystic fibrosis patients who are colonized with Pseudomonas aeruginosa [5]. Recently, some authors reported that colistin inhalation therapy is both tolerable and safe, and

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could be beneficial as an adjunctive therapy for the management of pneumonia due to colistin-only susceptible A. baumannii or P. aeruginosa [6, 7]. However, there have been no reports that have compared the clinical characteristics of patients with AKI that were treated with intravenous versus inhaled therapy.

Therefore, we investigated the incidence and clinical characteristics of acute kidney

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injury (AKI) after inhaled colistin compared with intravenous colistin using the RIFLE

METHODS

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criteria.

Patient selection

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From 2010 to 2014, 160 patients received intravenous or inhaled colistin. We

included patients who had received intravenous or inhaled colistin for treatment of pneumonia.

Patients were excluded if they received CMS for

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