Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11466-11485
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11466
Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis
Jiang-Lin Wang, Bi-Xiao Xiang, Xiao-Li Song, Rui-Man Que, Xiao-Cong Zuo, Yue-Liang Xie
Jiang-Lin Wang, Bi-Xiao Xiang, Rui-Man Que, Xiao-Cong Zuo, Yue-Liang Xie, Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Xiao-Li Song, Department of Pharmacy, Sanya Central Hospital, Sanya 572000, Hainan Province, China
Author contributions: Wang JL acquisition of data, analysis and interpretation of data, drafting the article, final approval; Xiang BX acquisition of data, final approval; Song XL acquisition of data, final approval; Que RM acquisition of data, final approval; Zuo XC critical revision, final approval; Xie YL conception and design of the study, critical revision, final approval.
Supported by The Hunan Province Natural Science Foundation, No. 2022JJ80043; Nature Science Foundation of Changsha, No. kq2014268; Hunan Engineering Research Center of Intelligent Prevention and Control for Drug Induced Organ Injury, No. 40; Scientific Research Fund Project of Hunan Pharmaceutical Society, No. 2020YXH010.
Conflict-of-interest statement: All the authors declare having no conflict of interest related to this work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist in detail, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue-Liang Xie, PharmD, Pharmacist, Department of Pharmacy, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. xieyliang@csu.edu.cn
Received: August 8, 2022
Peer-review started: August 8, 2022
First decision: September 5, 2022
Revised: September 15, 2022
Accepted: September 23, 2022
Article in press: September 23, 2022
Published online: November 6, 2022
ARTICLE HIGHLIGHTS
Research background

The prevalence of and risk factors for polymyxin-associated nephrotoxicity in intensive care unit (ICU) adult patients remain unclear.

Research motivation

The incidence of nephrotoxicity among polymyxin-treated patients is common and is one of the reasons why the use of polymyxins has been restricted. Nevertheless, the prevalence of and potential risk factors for polymyxin-induced nephrotoxicity in adult ICU patients are controversial. Therefore, a meta-analysis was carried out to assess the prevalence of and potential risk factors for polymyxin-induced nephrotoxicity.

Research objectives

This study aimed to meta-analyse reports evaluating the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult ICU patients.

Research methods

We performed a systematic literature search in PubMed, EMBASE, the Cochrane Library and RCA database from inception to May 30, 2022 and included eligible randomized clinical trials and observational studies in a meta-analysis evaluating the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult ICU patients.

Research results

The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%. Older age (particularly > 65 years), the presence of sepsis or septic shock, hypoalbuminemia and concomitant vancomycin or vasopressor use were risk factors for polymyxin-induced nephrotoxicity. In addition, our findings showed that a dosage regimen of 3 or 4 doses per day and dosage adjustment of colistin based on the renal baseline estimated glomerular filtration rate were associated with a lower nephrotoxicity rate.

Research conclusions

The incidence of polymyxin-induced nephrotoxicity was high in ICU adult patients. Patients with older age, the presence of sepsis or septic shock, and a decreased baseline glomerular filtration rate had a potentially higher risk of polymyxin-induced nephrotoxicity. A polymyxin dosage regimen of 3 or 4 doses per day, dosage adjustment of colistin based on the renal baseline estimated glomerular filtration rate, and avoidance of other nephrotoxic drugs (vancomycin or vasopressors) were helpful in decreasing the risk of polymyxin-induced nephrotoxicity.

Research perspectives

Exploring alternative treatments in patients with clinical or microbiologic carbapenem-resistant gram-negative bacterial infection treatment failures is required in the future to increase treatment efficacy and reduce adverse outcomes.