Yoğun bakımda kolistin nefrotoksisitesine etki eden faktörler

Öz

Amaç: Kolistin, yoğun bakım ünitelerinde çok ilaca dirençli gram-negatif enfeksiyonların tedavisinde sıklıkla kullanılmaktadır; ancak nefrotoksisite klinik kullanımının önemli bir sınırlılığıdır. Kolistine bağlı renal toksisitenin sıklığı ve risk faktörleri, özellikle kritik hastalarda, çalışmalar arasında değişkenlik göstermektedir. Bu çalışmada, intravenöz kolistin tedavisi alan yoğun bakım hastalarında renal toksisite insidansının ve ilişkili risk faktörlerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif gözlemsel kohort çalışmasına, 2013–2015 yılları arasında yoğun bakım ünitesinde intravenöz kolistin tedavisi alan 59 kritik hasta dahil edilmiştir. Nefrotoksisite, Acute Kidney Injury Network (AKIN) kriterlerine göre tanımlanmıştır. Klinik ve laboratuvar verileri analiz edilmiş; nefrotoksisite ile ilişkili değişkenler uygun istatistiksel testlerle değerlendirilmiş ve bağımsız belirleyicileri saptamak amacıyla çok değişkenli analiz uygulanmıştır. Bulgular: Hastaların %67,8’inde nefrotoksisite gelişmiştir. Düzeltilmemiş analizlerde ileri yaş, koroner arter hastalığı varlığı ve yüksek başlangıç kan üre azotu (BUN) düzeyleri toksisite ile ilişkili bulunmuştur. Ancak çok değişkenli analiz sonrasında yalnızca yüksek başlangıç BUN düzeyinin nefrotoksisite ile bağımsız olarak ilişkili olduğu saptanmıştır. Renal bozulma en sık tedavinin ilk haftasında ortaya çıkmış ve hastaların %8,5’inde renal replasman tedavisi gereksinimi gelişmiştir. Kolistin dozu nefrotoksisite ile bağımsız olarak ilişkili bulunmamıştır. Sonuçlar: Kolistine bağlı nefrotoksisite kritik hastalarda sık görülmekte ve genellikle tedavinin erken döneminde gelişmektedir. Özellikle yüksek başlangıç BUN düzeyi ile yansıyan azalmış renal fonksiyon rezervi, toksisite gelişimine yatkınlığı artırmaktadır. Kolistin tedavisi sırasında erken risk değerlendirmesi yapılması ve böbrek fonksiyonlarının yakından izlenmesi önemlidir.

Anahtar Kelimeler

• kolistin
• nefrotoksisite
• yoğun bakım
• risk faktörleri
• akut böbrek hasarı

Factors affecting colistin nephrotoxicity in intensive care units

Öz

Aim: Colistin is frequently used for the treatment of multidrug-resistant gram-negative infections in intensive care units; however, nephrotoxicity remains a major limitation of its clinical use. The incidence and risk factors of colistin-associated renal toxicity vary across studies, particularly in critically ill populations. This study aimed to evaluate the incidence of renal toxicity and associated risk factors in intensive care unit patients receiving intravenous colistin therapy. Material and Methods: This retrospective observational cohort study included 59 critically ill patients who received intravenous colistin therapy between 2013 and 2015. Nephrotoxicity was defined according to the Acute Kidney Injury Network criteria. Clinical and laboratory data were analyzed. Variables associated with nephrotoxicity were assessed using appropriate statistical tests, and multivariate analysis was performed to identify independent predictors. Results: Nephrotoxicity developed in 67.8% of patients. Older age, coronary artery disease and higher baseline blood urea nitrogen were associated with toxicity in unadjusted analyses. After adjustment, only elevated baseline blood urea nitrogen remained independently associated with nephrotoxicity. Renal impairment most commonly occurred within the first week of therapy, and 8.5% of patients required renal replacement therapy. Colistin dose was not independently associated with nephrotoxicity. Conclusion: Colistin-associated nephrotoxicity was common and typically developed early in critically ill patients. Reduced baseline renal functional reserve, particularly reflected by elevated blood urea nitrogen levels, appears to increase susceptibility to toxicity. Close renal monitoring and early risk assessment are essential during colistin therapy. Keywords: colistin, nephrotoxicity, intensive care, risk factors, acute kidney injury

Anahtar Kelimeler

• colistin
• nephrotoxicity
• intensive care
• risk factors
• acute kidney injury

Kaynakça

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