Current Incidence and Risk Factors for Polymyxin B-Associated Acute Kidney Injury In Patients With Septic Shock

Summary

This study evaluates the incidence and risk factors of polymyxin B-induced acute kidney injury (AKI) in septic shock patients through clinical observation, laboratory monitoring, and nursing intervention.

Abstract

This study evaluates the incidence and risk factors of polymyxin B-associated acute kidney injury (AKI) in patients with septic shock, a population at high risk of nephrotoxicity due to critical illness and exposure to last-line antibiotics. A prospective cohort of 200 adult patients with microbiologically confirmed multidrug-resistant gram-negative infections was analyzed. All patients received intravenous polymyxin B with standardized dosing and renal monitoring based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. AKI occurred in 25% of patients, with a median onset of 4 days following initiation of therapy. Significant risk factors included higher baseline body mass index, elevated serum urea and creatinine, reduced glomerular filtration rate, presence of comorbidities, and concomitant use of nephrotoxic agents. Structured nursing interventions and standardized monitoring enabled early detection of renal dysfunction and timely dose adjustment. These findings highlight the importance of systematic renal surveillance and individualized therapeutic strategies, including therapeutic drug monitoring, to minimize nephrotoxicity in septic shock patients receiving polymyxin B.

Introduction

It is noteworthy that there have been several changes in the concept of Acute Renal Failure (ARF) in the recent past. Traditionally, more attention was paid to the first type of acute change in the level of kidney failure indicating marked azotaemia and often oligo- or anuria. However, recent data show that even minor renal injuries or dysfunctions characterized by low increases in sCr and/or UO can be potential markers of significant clinical consequences. Acute renal failure was replaced by the term Acute Kidney Injury (AKI) recently. AKI is defined by an abrupt (within h ) reduction in renal function that encompasses both structural and functional changes

Protocol

Material and methods

A total of 260 patients were screened, of which 200 met inclusion criteria and were enrolled. Sixty patients were excluded due to polymyxin B duration ≤ 72 h or incomplete data. 72 h exclusion threshold was selected based on evidence indicating that clinically significant polymyxin B-associated nephrotoxicity typically develops after sustained drug exposure beyond 48–72 h, thereby minimizing misclassification of early transient renal fluctuations unrelated to drug toxicity.

This was a single-centered, prospective cohort study in a large tertiary care teaching hospital to eval....

Results

Incidence of AKI

A total of 200 patients were evaluated. Mean age of the patients was 68.3 years with 59% of the patients being males. Mean BMI was 24.9 Kg·(m²)^-1. Current incidence of AKI was 25%. Mean Urea (mg·dL^-1), Creatinine (mg·dL^-1), AST (U·L^-1), ALT (U·L^-1) and GFR levels were found to be 89.2, 1.1, 26.2, 27.1 and 89.5 respectively. It was seen that higher BMI, raised urea levels, raised creatinine level.......

Discussion

The findings demonstrate that AKI occurred in 25% of patients, with significant associations observed for higher baseline body mass index, elevated urea and creatinine levels, reduced glomerular filtration rate, presence of comorbidities, and concomitant nephrotoxic drug exposure.

Common challenges include variability in urine output measurement and incomplete documentation of nephrotoxic drug exposure. These can be addressed through strict ICU monitoring study and standardized case report for.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
APACHE-II scoring software	IBM SPSS Statistics v25.0	—	Used for patient severity scoring and statistical analysis
Automated biochemical analyzer	Beckman Coulter AU5800 (USA)	N/A	For biochemical and hepatic function tests
Complete blood count analyzer	Sysmex XN-1000 (Japan)	N/A	For hematological analysis (Hb, WBC, RBC indices)
KDIGO 2012 clinical criteria	Kidney Disease: Improving Global Outcomes	—	Used for AKI classification (Stages 1–3)
Patient monitoring system	Mindray BeneView T8 (Shenzhen, China)	N/A	Continuous hemodynamic and urine output monitoring
Polymyxin B sulfate for injection	Xian Janssen Pharmaceutical Co., Ltd. (China)	N/A	Administered intravenously as 2.5 mg/kg loading dose and 1.5 mg/kg/day maintenance dose
Serum creatinine and urea kits	Roche Diagnostics GmbH, Mannheim, Germany	11875599 / 11875583	Used for renal function monitoring
SPSS software	IBM, Armonk, NY, USA	Version 25.0	For statistical analyses including logistic regression
Vasopressor agents (norepinephrine, dopamine)	Jiangsu Nhwa Pharmaceutical Co., Ltd.	N/A	Used to maintain MAP ≥ 65 mmHg in septic shock management