Nephrotoxicity and Efficacy Assessment of Polymyxin B Use in Renal Transplant Patients

Abstract

Yu-Xin Wen,1,2,* Qiang Qu,3,4,* Wen-Ming Long,5 Yue Luo,6 Hai-Hui Zhuang,1 Xin-Qi Teng,1 Jian Qu1 1Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, 410011, People’s Republic of China; 2Department of Pharmacy, Lixian People’s Hospital in Hunan, Lixian, 415500, People’s Republic of China; 3Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410078, People’s Republic of China; 4National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, People’s Republic of China; 5Department of Pharmacy, Jingzhou District, Second People’s Hospital of Huaihua City, Huaihua, 418400, People’s Republic of China; 6Department of Pharmacy, The People’s Hospital of Liuyang, Liuyang, 410300, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian QuDepartment of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, People’s Republic of China, Tel [phone], Fax [phone]Email [email protected]: This study investigates the nephrotoxicity and efficacy assessment of polymyxin B (PMB) use in renal transplant patients.Patients and Methods: This retrospective study included adult (> 18 years of age) renal transplant patients who received PMB intravenous drip for more than 72 hours. Efficacy assessment of PMB included clinical treatment efficacy, microbiological efficacy at the end of PMB treatment, and in-hospital all-cause mortality. Nephrotoxicity of PMB was evaluated for further group comparison.Results: We enrolled 235 renal transplant patients in our study. After PMB treatment, 45 patients occurred PMB-nephrotoxicity, and the nephrotoxicity rate was 19.15%. Among them, 44 patients were RIFLE R stage, and one patient was RIFLE I stage. The dose of PMB used in patients was 40.0 (40.0– 50.0) mg q12h with a loading dose of 41.8± 9.8 mg. Multivariate logistic regression analysis showed that ICU admission, vasoactive agents, aminoglycosides, creatinine clearance rate before PMB use, and mean total hospital stay were independent risk factors of PMB-nephrotoxicity in kidney transplant patients. The clinical effective rate was 97.9%, and the microbiological clean rate was 66.7%.Conclusion: Our study demonstrated that PMB low dose regimens might achieve good efficacy and less nephrotoxicity in renal transplant patients. We should evaluate the severity of the infection and renal function of patients, avoid the combined use of other nephrotoxic drugs, and minimize the course of use to reduce the occurrence of PMB-nephrotoxicity.Keywords: polymyxin B, nephrotoxicity, renal transplant patients, adverse reactions

Keywords

• polymyxin b
• nephrotoxicity
• renal transplant patients
• adverse reactions