Colistin Use in Patients with Chronic Kidney Disease : Are We Underdosing Patients?
Sorlí, Luisa (Hospital del Mar (Barcelona, Catalunya))
Luque, Sonia (Hospital del Mar (Barcelona, Catalunya))
Li, Jian (Monash University)
Rodríguez García, Eva (Institut Hospital del Mar d'Investigacions Mèdiques)
Campillo, Núria (Institut Hospital del Mar d'Investigacions Mèdiques)
Fernández-Sala, Xènia (Institut Hospital del Mar d'Investigacions Mèdiques)
Soldado, Jade (Institut Hospital del Mar d'Investigacions Mèdiques)
Domingo, Ignacio (Hospital del Mar (Barcelona, Catalunya))
Montero, Milagro (Institut Hospital del Mar d'Investigacions Mèdiques)
Grau, Santiago (Hospital del Mar (Barcelona, Catalunya))
Horcajada, Juan Pablo. (Hospital del Mar (Barcelona, Catalunya))
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Colistin is administered as its inactive prodrug colistimethate (CMS). Selection of an individualized CMS dose for each patient is difficult due to its narrow therapeutic window, especially in patients with chronic kidney disease (CKD). Our aim was to analyze CMS use in patients with CKD. Secondary objectives were to assess the safety and efficacy of CMS in this special population. In this prospective observational cohort study of CMS-treated CKD patients, CKD was defined as the presence of a glomerular filtration rate (GFR) < 60 mL/min/m 2 for more than 3 months. The administered doses of CMS were compared with those recently published in the literature. Worsened CKD at the end of treatment (EOT) was evaluated with the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Colistin plasma concentrations (C) were measured using high-performance liquid chromatography. Fifty-nine patients were included. Thirty-six (61. 2%) were male. The median age was 76 (45-95) years and baseline GFR was 36. 6 ± 13. 6. The daily mean CMS dosage used was compared with recently recommended doses (3. 36 vs. 6. 07; p < 0. 001). Mean C was 0. 9 (0. 2-2. 9) mg/L, and C was <2 mg/L in 50 patients (83. 3%). Clinical cure was achieved in 43 (72. 9%) patients. Worsened renal function at EOT was present in 20 (33. 9%) patients and was reversible in 10 (52. 6%). The CMS dosages used in this cohort were almost half those currently recommended. The mean achieved C were under the recommended target of 2 mg/dL. Despite this, clinical cure rate was high. In this patient cohort, the incidence of nephrotoxicity was similar to those found in other recent studies performed in the general population and was reversible in 52. 6%. These results suggest that CMS is safe and effective in patients with CKD and may encourage physicians to adjust dosage regimens to recent recommendations in order to optimize CMS treatments.
Ajuts:	Instituto de Salud Carlos III PS09-01634
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Colistin ; Colistin plasma concentrations ; Chronic kidney disease ; Pharmacokinetic ; Toxicodynamic
Publicat a:	Molecules, Vol. 24 (february 2019) , ISSN 1420-3049

DOI: 10.3390/molecules24030530
PMID: 30717123

12 p, 398.4 KB

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