Abstract：
(1) Background: It is not known whether different daily dosing schemes have different effects on colistin nephrotoxicity. We examined the effect of once- versus twice- or thrice-daily doses of colistin on renal function. (2) Methods: We performed a multicenter retrospective cohort study of hospitalized patients with a baseline glomerular filtration rate ≥ 50 mL/min who received intravenously the same colistin dose once (regimen A), twice (regimen B) or thrice daily (regimen C). The primary endpoint was acute kidney injury (AKI), defined as fulfilment of any of the RIFLE (Risk-Injury-Failure-Loss-End stage renal disease) criteria. (3) Results: We included 306 patients; 132 (43.1%) received regimen A, 151 (49.3%) regimen B, and 23 (7.5%) regimen C. Ninety-nine (32.4%) patients developed AKI; there was no difference between regimen A vs. B and C [45 (34.1%) vs. 54 (31.0%), p = 0.57]. In a propensity score−matched cohort, AKI was similar in patients receiving Regimen A, Regimen B, and Regimen C (31.6% vs. 33.3%, p = 0.78). On logistic regression analysis, diabetes was an independent predictor of AKI (OR = 4.59, 95% CI 2.03−10.39, p = 0.001) while eGFR > 80 mL/min (OR = 0.50, 95% CI 0.25−0.99, p = 0.048) was inversely associated with AKI. (4) Conclusions: Colistin once daily is not more nephrotoxic than the standard colistin regimens. The only independent predictor of nephrotoxicity was diabetes mellitus, while eGFR > 80 mL/min had a protective effect.
摘要：
（1）背景：不同的日给药方案对粘菌素肾毒性的影响是否不同，目前尚不清楚。我们检查了每天两次或两次或三次剂量的粘菌素对肾功能的影响。（2）方法：我们对基线肾小球滤过率≥50mL/min的住院患者进行了多中心回顾性队列研究，这些患者静脉内接受了相同剂量的粘菌素一次（方案A），每天两次（方案B）或三次（方案C）。主要终点是急性肾损伤（AKI），定义为满足任何RIFLE（风险-损伤-失败-损失-终末期肾病）标准。（3）结果：我们纳入306例患者；132例（43.1％）接受方案A，151（49.3%）方案B，和23（7.5％）方案C。九十九（32.4％）患者发生AKI；方案A与方案A之间没有差异B和C[45（34.1%）与54（31.0%），p=0.57]。在倾向得分匹配的队列中，AKI在接受方案A的患者中相似，方案B，和方案C（31.6%与33.3%,p=0.78）。在逻辑回归分析中，糖尿病是AKI的独立预测因子(OR=4.59,95%CI2.03-10.39,p=0.001),而eGFR>80mL/min(OR=0.50,95%CI0.25-0.99,p=0.048)与AKI呈负相关。（4）结论：粘菌素每天一次的肾毒性并不比标准粘菌素方案高。肾毒性的唯一独立预测因素是糖尿病，而eGFR>80mL/min有保护作用。
