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Colistin is relevant in the treatment of infections caused by multidrug-resistant microorganisms; however, it is not exempt from adverse renal events such as acute kidney injury (AKI), acute tubular dysfunction (ATD) and electrolyte imbalances, the latter two being little described in the literature. Therefore, the present study aimed to describe and analyze the electrolyte and urinary excretion disorders associated with the prescription of colistin, as well as the associated renal outcomes.
Retrospective cohort study. Data were obtained between January 2022 and June 2023. Adult patients who received colistin for at least 48 hours were included. Patients with AKI at baseline, without laboratory studies, on renal replacement therapy or with stage 3-5 chronic kidney disease (CKD) were excluded. The variables were: development of AKI, electrolyte imbalances, urinary excretion of electrolytes and renal function outcome at three months.
Of 79 cases of colistin use, 38 were included for study. The mean age was 52.51 years (21.89-88.47), 55.26% of the patients were women and the main microorganism isolated was Pseudomonas aeruginosa (57.89%). The incidence of AKI was 47.36% (n=18). For the analysis of outcomes, patients were divided into two groups: one with those who developed AKI during treatment and the other with those who did not. In the group with AKI, at three months: 8 (44.44%) returned to their baseline renal function, 5 died (27.77%), 2 (11.11%) did not recover their baseline renal function and 3 (16.66%) were lost to follow-up. In the group without AKI, at three months: 13 (65%) remained without deterioration of renal function, 4 died (20%) and 3 (15%) lost to follow-up. Patients with AKI had an odds ratio for death of 1.62 (CI 95%, 0.34-7.67%). The electrolyte disorders with the highest incidence were: hyponatremia (34.21%), hypokalemia (52.63%), hyperchloremia (44.73%); hypocalcemia (84.21%), hypophosphatemia (52.63%) and hypomagnesemia (76.31%). In those with urinary electrolytes determination, an increase in the excretion of potassium (100%), magnesium (100%) and phosphorus (75%) was consistently found (Table 1).
In patients who were administered colistin: mortality was higher when they developed AKI during treatment, they presented a high incidence of electrolyte imbalances with hypocalcemia and hypomagnesemia standing out as the most frequent; in addition, the evaluation of urinary excretion of potassium, phosphate and magnesium provides data highly suggestive of acute tubular dysfunction, an event rarely reported in the literature which causes high comorbidity if the imbalance is not treated.