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Nephrotoxicity Associated with Intravenous Polymyxin B Once- versus Twice-Daily Dosing Regimen
Nephrotoxicity is a known adverse effect of polymyxin B (PMB). Animal data suggest that once-daily dosing may reduce the rate and delay the onset of acute kidney injury (AKI). In a multicenter retrospective study, we evaluated adult patients with a creatinine clearance (CrCl) of ≥30 ml/min who recei...
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| Published in: | Antimicrobial agents and chemotherapy 2018-08, Vol.62 (8) |
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| container_title | Antimicrobial agents and chemotherapy |
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| creator | Okoduwa, Adeola Ahmed, Nabeela Guo, Yi Scipione, Marco R Papadopoulos, John Eiras, Daniel P Dubrovskaya, Yanina |
| description | Nephrotoxicity is a known adverse effect of polymyxin B (PMB). Animal data suggest that once-daily dosing may reduce the rate and delay the onset of acute kidney injury (AKI). In a multicenter retrospective study, we evaluated adult patients with a creatinine clearance (CrCl) of ≥30 ml/min who received ≥48 h of PMB therapy. The primary endpoint was the difference in rate of AKI comparing once- and twice-daily PMB dosing. The secondary endpoints included the time to AKI and the recovery of renal function. Of 273 eligible patients, 100 from each group were matched on the basis of propensity scores. In the matched groups, nephrotoxicity, defined according to risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria, was more frequent with once- than with twice-daily dosing (47% versus 17%, respectively;
= 0.0005). After adjusting for residual differences by multivariate conditional logistic regression, once-daily dosing was more likely to result in nephrotoxicity (adjusted odds ratio, 2.5; 95% confidence interval [CI], 1.413 to 4.541;
= 0.002). Among 64 patients who developed AKI, the median onsets were similar between the groups (7 days with once versus 6 days with twice-daily dosing,
= 0.095). Of 37 patients who had their serum creatinine evaluated subsequently, 29/37 (78%) had recovery of renal function. No patient required renal replacement therapy. Our findings suggest that AKI is significantly more common with PMB once daily than with twice-daily dosing with no difference in time to AKI. A prospective randomized study is warranted to validate these results. |
| doi_str_mv | 10.1128/AAC.00025-18 |
| format | article |
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= 0.0005). After adjusting for residual differences by multivariate conditional logistic regression, once-daily dosing was more likely to result in nephrotoxicity (adjusted odds ratio, 2.5; 95% confidence interval [CI], 1.413 to 4.541;
= 0.002). Among 64 patients who developed AKI, the median onsets were similar between the groups (7 days with once versus 6 days with twice-daily dosing,
= 0.095). Of 37 patients who had their serum creatinine evaluated subsequently, 29/37 (78%) had recovery of renal function. No patient required renal replacement therapy. Our findings suggest that AKI is significantly more common with PMB once daily than with twice-daily dosing with no difference in time to AKI. A prospective randomized study is warranted to validate these results.</description><identifier>ISSN: 0066-4804</identifier><identifier>EISSN: 1098-6596</identifier><identifier>DOI: 10.1128/AAC.00025-18</identifier><identifier>PMID: 29844039</identifier><language>eng</language><publisher>United States: American Society for Microbiology</publisher><subject>Acinetobacter Infections ; Acute Kidney Injury ; Anti-Bacterial Agents ; Clinical Therapeutics ; Kidney Failure, Chronic ; Klebsiella Infections ; Polymyxin B ; Pseudomonas Infections</subject><ispartof>Antimicrobial agents and chemotherapy, 2018-08, Vol.62 (8)</ispartof><rights>Copyright © 2018 American Society for Microbiology.</rights><rights>Copyright © 2018 American Society for Microbiology. 2018 American Society for Microbiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a3338-d35684a86c9a04903eb6a09ec6ab0866cd3619978c4c3e011ff6b4c85b811ccd3</citedby><cites>FETCH-LOGICAL-a3338-d35684a86c9a04903eb6a09ec6ab0866cd3619978c4c3e011ff6b4c85b811ccd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.asm.org/doi/pdf/10.1128/AAC.00025-18$$EPDF$$P50$$Gasm2$$H</linktopdf><linktohtml>$$Uhttps://journals.asm.org/doi/full/10.1128/AAC.00025-18$$EHTML$$P50$$Gasm2$$H</linktohtml><link.rule.ids>230,315,733,786,790,891,3207,27957,27958,52786,52787,52788,53827,53829</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29844039$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Okoduwa, Adeola</creatorcontrib><creatorcontrib>Ahmed, Nabeela</creatorcontrib><creatorcontrib>Guo, Yi</creatorcontrib><creatorcontrib>Scipione, Marco R</creatorcontrib><creatorcontrib>Papadopoulos, John</creatorcontrib><creatorcontrib>Eiras, Daniel P</creatorcontrib><creatorcontrib>Dubrovskaya, Yanina</creatorcontrib><title>Nephrotoxicity Associated with Intravenous Polymyxin B Once- versus Twice-Daily Dosing Regimen</title><title>Antimicrobial agents and chemotherapy</title><addtitle>Antimicrob Agents Chemother</addtitle><addtitle>Antimicrob Agents Chemother</addtitle><description>Nephrotoxicity is a known adverse effect of polymyxin B (PMB). Animal data suggest that once-daily dosing may reduce the rate and delay the onset of acute kidney injury (AKI). In a multicenter retrospective study, we evaluated adult patients with a creatinine clearance (CrCl) of ≥30 ml/min who received ≥48 h of PMB therapy. The primary endpoint was the difference in rate of AKI comparing once- and twice-daily PMB dosing. The secondary endpoints included the time to AKI and the recovery of renal function. Of 273 eligible patients, 100 from each group were matched on the basis of propensity scores. In the matched groups, nephrotoxicity, defined according to risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria, was more frequent with once- than with twice-daily dosing (47% versus 17%, respectively;
= 0.0005). After adjusting for residual differences by multivariate conditional logistic regression, once-daily dosing was more likely to result in nephrotoxicity (adjusted odds ratio, 2.5; 95% confidence interval [CI], 1.413 to 4.541;
= 0.002). Among 64 patients who developed AKI, the median onsets were similar between the groups (7 days with once versus 6 days with twice-daily dosing,
= 0.095). Of 37 patients who had their serum creatinine evaluated subsequently, 29/37 (78%) had recovery of renal function. No patient required renal replacement therapy. Our findings suggest that AKI is significantly more common with PMB once daily than with twice-daily dosing with no difference in time to AKI. A prospective randomized study is warranted to validate these results.</description><subject>Acinetobacter Infections</subject><subject>Acute Kidney Injury</subject><subject>Anti-Bacterial Agents</subject><subject>Clinical Therapeutics</subject><subject>Kidney Failure, Chronic</subject><subject>Klebsiella Infections</subject><subject>Polymyxin B</subject><subject>Pseudomonas Infections</subject><issn>0066-4804</issn><issn>1098-6596</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kc1PAjEQxRujEURvnk2vJi5O6W5pLyYIfpAQMQavNt1SoITdku3ysf-9RZTowdNk8nvzMvMGoUsCTUJa_LbT6TYBoJVEhB-hOgHBI5YIdozqAIxFMYe4hs68nwdVAHCKai3B4xioqKOPF7OcFa50W6ttWeGO905bVZox3thyhvt5Wai1yd3K41e3qLJqa3N8j4e5NhFem8IHMNrY0PWUXVS457zNp_jNTG1m8nN0MlELby6-awO9Pz6Mus_RYPjU73YGkaKU8mhME8ZjxZkWCmIB1KRMgTCaqRQ4Y3pMGRGizXWsqQFCJhOWxponKSdEB9pAd3vf5SrNzFib3doLuSxspopKOmXlX5LbmZy6tWQEkjYXweBmb6AL531hJodZAnKXsww5y6-cJeFBfr2XK5-15Nytijyc95_26vduB-OfJ9BPDcuHAA</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Okoduwa, Adeola</creator><creator>Ahmed, Nabeela</creator><creator>Guo, Yi</creator><creator>Scipione, Marco R</creator><creator>Papadopoulos, John</creator><creator>Eiras, Daniel P</creator><creator>Dubrovskaya, Yanina</creator><general>American Society for Microbiology</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20180801</creationdate><title>Nephrotoxicity Associated with Intravenous Polymyxin B Once- versus Twice-Daily Dosing Regimen</title><author>Okoduwa, Adeola ; Ahmed, Nabeela ; Guo, Yi ; Scipione, Marco R ; Papadopoulos, John ; Eiras, Daniel P ; Dubrovskaya, Yanina</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a3338-d35684a86c9a04903eb6a09ec6ab0866cd3619978c4c3e011ff6b4c85b811ccd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Acinetobacter Infections</topic><topic>Acute Kidney Injury</topic><topic>Anti-Bacterial Agents</topic><topic>Clinical Therapeutics</topic><topic>Kidney Failure, Chronic</topic><topic>Klebsiella Infections</topic><topic>Polymyxin B</topic><topic>Pseudomonas Infections</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Okoduwa, Adeola</creatorcontrib><creatorcontrib>Ahmed, Nabeela</creatorcontrib><creatorcontrib>Guo, Yi</creatorcontrib><creatorcontrib>Scipione, Marco R</creatorcontrib><creatorcontrib>Papadopoulos, John</creatorcontrib><creatorcontrib>Eiras, Daniel P</creatorcontrib><creatorcontrib>Dubrovskaya, Yanina</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Antimicrobial agents and chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Okoduwa, Adeola</au><au>Ahmed, Nabeela</au><au>Guo, Yi</au><au>Scipione, Marco R</au><au>Papadopoulos, John</au><au>Eiras, Daniel P</au><au>Dubrovskaya, Yanina</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nephrotoxicity Associated with Intravenous Polymyxin B Once- versus Twice-Daily Dosing Regimen</atitle><jtitle>Antimicrobial agents and chemotherapy</jtitle><stitle>Antimicrob Agents Chemother</stitle><addtitle>Antimicrob Agents Chemother</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>62</volume><issue>8</issue><issn>0066-4804</issn><eissn>1098-6596</eissn><notes>Citation Okoduwa A, Ahmed N, Guo Y, Scipione MR, Papadopoulos J, Eiras DP, Dubrovskaya Y. 2018. Nephrotoxicity associated with intravenous polymyxin B once- versus twice-daily dosing regimen. Antimicrob Agents Chemother 62:e00025-18. https://doi.org/10.1128/AAC.00025-18.</notes><notes>Present address: Adeola Okoduwa, Mount Sinai Medical Center, New York, New York, USA; Nabeela Ahmed, NYU Langone Hospital—Brooklyn, Brooklyn, New York, USA; Marco R. Scipione, Memorial Sloan Kettering Cancer Center, New York, New York, USA.</notes><abstract>Nephrotoxicity is a known adverse effect of polymyxin B (PMB). Animal data suggest that once-daily dosing may reduce the rate and delay the onset of acute kidney injury (AKI). In a multicenter retrospective study, we evaluated adult patients with a creatinine clearance (CrCl) of ≥30 ml/min who received ≥48 h of PMB therapy. The primary endpoint was the difference in rate of AKI comparing once- and twice-daily PMB dosing. The secondary endpoints included the time to AKI and the recovery of renal function. Of 273 eligible patients, 100 from each group were matched on the basis of propensity scores. In the matched groups, nephrotoxicity, defined according to risk, injury, failure, loss, and end-stage renal disease (RIFLE) criteria, was more frequent with once- than with twice-daily dosing (47% versus 17%, respectively;
= 0.0005). After adjusting for residual differences by multivariate conditional logistic regression, once-daily dosing was more likely to result in nephrotoxicity (adjusted odds ratio, 2.5; 95% confidence interval [CI], 1.413 to 4.541;
= 0.002). Among 64 patients who developed AKI, the median onsets were similar between the groups (7 days with once versus 6 days with twice-daily dosing,
= 0.095). Of 37 patients who had their serum creatinine evaluated subsequently, 29/37 (78%) had recovery of renal function. No patient required renal replacement therapy. Our findings suggest that AKI is significantly more common with PMB once daily than with twice-daily dosing with no difference in time to AKI. A prospective randomized study is warranted to validate these results.</abstract><cop>United States</cop><pub>American Society for Microbiology</pub><pmid>29844039</pmid><doi>10.1128/AAC.00025-18</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | Open Access: PubMed Central; American Society for Microbiology Journals |
| subjects | Acinetobacter Infections Acute Kidney Injury Anti-Bacterial Agents Clinical Therapeutics Kidney Failure, Chronic Klebsiella Infections Polymyxin B Pseudomonas Infections |
| title | Nephrotoxicity Associated with Intravenous Polymyxin B Once- versus Twice-Daily Dosing Regimen |
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