Colistimethate sodium and acute kidney injury: Incidence, risk factors, outcome and prognosis of renal function / Fracaso renal agudo y colistimetato de sodio: incidencia, factores de riesgo, resultados y pronóstico de la función renal

BACKGROUND: Colistimethate sodium (CMS) treatment has increased over the last years, being acute kidney injury (AKI) its main drug-related adverse event. Therefore, this study aimed to evaluate the incidence and risk factors associated with AKI, as well as identifying the factors that determine renal function (RF) outcomes at six months after discharge. MATERIALS AND METHODS: This retrospective study included adult septic patients receiving intravenous CMS for at least 48 h (January 2007-December 2014). AKI was assessed using KDIGO criteria. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD equation. Logistic and linear models were performed to evaluate the risk factors for AKI and chronic kidney disease (CKD). RESULTS: Among 126 patients treated with CMS; the incidence of AKI was 48.4%. Sepsis-severe sepsis (OR 8.07, P = 0.001), sepsis-septic shock (OR 42.9, P < 0.001), and serum creatinine (SCr) at admission (OR 6.20, P = 0.009) were independent predictors. Eighty-four patients survived; the main factors for RF evolution at the 6-month follow-up was baseline eGFR (0.58, P < 0.001) and at discharge (0.34, P < 0.001). Fifty-six percent (34/61) of the patients that developed AKI survived. At six months, 32% had CKD. CONCLUSIONS: The development of AKI in septic patients with CMS treatment was associated with sepsis severity and SCr at admission. Baseline eGFR and eGFR at discharge were and important determinant of the RF at the 6-month follow-up. These predictors may assist in clinical decision making for this patient population

INTRODUCCIÓN: El tratamiento con colistimetato de sodio (CMS) se ha incrementado, siendo su principal complicación el fracaso renal agudo (FRA). El objetivo de este estudio fue determinar la incidencia de FRA y los factores de riesgo asociados, así como identificar los factores que determinan la función renal (FR) a los 6 meses del alta hospitalaria. MATERIALES Y MÉTODOS: Estudio retrospectivo que incluyó pacientes adultos sépticos que recibieron CMS intravenoso durante al menos 48 h (enero 2007-diciembre 2014). El diagnóstico de FRA se realizó según los criterios KDIGO. Se estimó el filtrado glomerular (FG) mediante la ecuación del MDRD-4. Se realizaron modelos logísticos y lineales para evaluar los factores de riesgo para el desarrollo de FRA y enfermedad renal crónica (ERC). RESULTADOS: Ciento veintiséis pacientes fueron incluidos; la incidencia de FRA fue del 48,4%. Sepsis-sepsis severa (OR: 8,07; p = 0,001), sepsis-shock séptico (OR: 42,9; p < 0,001) y la creatinina sérica (CRs) al ingreso (OR: 6,20; p = 0,009) fueron predictores independientes de FRA. Ochenta y cuatro pacientes sobrevivieron; el determinante principal de la evolución de la FR a los 6 meses de seguimiento fue el FGe basal (0,58; p < 0,001) y al alta (0,34; p < 0,001). El 56% (34/61) de los pacientes que desarrollaron FRA sobrevivieron. A los 6 meses, el 32% desarrollo ERC. CONCLUSIONES: El desarrollo de FRA asociado al tratamiento con CMS se asoció con el grado de severidad de la sepsis y la CRs al ingreso. El FGe basal y al alta hospitalaria fueron predictores independientes de la FR a los 6 meses de seguimiento

Colistimethate sodium and acute kidney injury: Incidence, risk factors, outcome and prognosis of renal function.

BACKGROUND: Colistimethate sodium (CMS) treatment has increased over the last years, being acute kidney injury (AKI) its main drug-related adverse event. Therefore, this study aimed to evaluate the incidence and risk factors associated with AKI, as well as identifying the factors that determine renal function (RF) outcomes at six months after discharge. MATERIALS AND METHODS: This retrospective study included adult septic patients receiving intravenous CMS for at least 48h (January 2007-December 2014). AKI was assessed using KDIGO criteria. The glomerular filtration rate (GFR) was estimated by the 4-variable MDRD equation. Logistic and linear models were performed to evaluate the risk factors for AKI and chronic kidney disease (CKD). RESULTS: Among 126 patients treated with CMS; the incidence of AKI was 48.4%. Sepsis-severe sepsis (OR 8.07, P=0.001), sepsis-septic shock (OR 42.9, P<0.001), and serum creatinine (SCr) at admission (OR 6.20, P=0.009) were independent predictors. Eighty-four patients survived; the main factors for RF evolution at the 6-month follow-up was baseline eGFR (0.58, P<0.001) and at discharge (0.34, P<0.001). Fifty-six percent (34/61) of the patients that developed AKI survived. At six months, 32% had CKD. CONCLUSIONS: The development of AKI in septic patients with CMS treatment was associated with sepsis severity and SCr at admission. Baseline eGFR and eGFR at discharge were and important determinant of the RF at the 6-month follow-up. These predictors may assist in clinical decision making for this patient population.

Fall-risk increasing drugs and prevalence of polypharmacy in older patients discharged from an Orthogeriatric Unit after a hip fracture.

BACKGROUND: Polypharmacy and fall-risk increasing drugs (FRIDS) have been associated with injurious falls. We aimed to estimate the prevalence of polypharmacy and FRIDS in older patients discharged from an Orthogeriatric Unit after a hip fracture surgery. METHODS: This study describes the baseline findings of a 2-year retrospective cohort study. We included patients older than 80 years discharged from an Orthogeriatric Unit who were able to walk before surgery. Patient's baseline variables, total number of drugs, and FRIDS at hospital discharge were collected. RESULTS: We included 228 patients. The mean number of drugs and FRIDS prescribed at discharge was 11.6 ± 3.0 and 2.9 ± 1.6, respectively. Polypharmacy was prevalent in all patients except in three: 23.3% (5-9 drugs) and 75.9% (≥ 10 drugs). Only 11 patients had no FRIDS and 35.5% were on > 3 FRIDS. The most prevalent FRIDS were: agents acting on the renin-angiotensin system (43.9%) and anxiolytics (39.9%). The number of FRIDS was higher in patients with extreme polypharmacy (3.4 ± 1.5) than in those on 5-9 drugs (1.5 ± 1.0, p < 0.05). Independent people in performing instrumental activities had lower risk of extreme polypharmacy (≥ 10 drugs) or > 3 FRIDS: OR 0.39 (95% CI 0.18-0.83) and OR 0.41 (95% CI 0.20-0.84), respectively. People living in a nursing home had higher risk of > 3 FRIDS: OR 4.03 (95% CI 1.12-14.53). CONCLUSIONS: Polypharmacy and fall-risk increasing drugs are prevalent in patients discharged from orthogeriatric care after surgery for a hip fracture. Interventions on drug use at hospital discharge could have a potential impact on falls in this high-risk population.

Carga anticolinérgica y delirium en pacientes mayores durante la hospitalización en una unidad de agudos de geriatría / Anticholinergic burden and delirium in elderly patients during acute hospital admission

Introducción. La utilización de fármacos anticolinérgicos en mayores se ha relacionado con mayor aparición de delirium. Existen distintas escalas que permiten estimar la carga anticolinérgica como la Anticholinergic Drug Scale (ADS), la Anticholinergic Risk Scale (ARS) y la Anticholinergic Cognitive Burden (ACB). El objetivo de este estudio es establecer una asociación entre delirium, incidente y prevalente, y la carga anticolinérgica según las escalas mencionadas en mayores hospitalizados. Método. Estudio observacional ambispectivo de 76 días de duración realizado en la unidad de agudos de geriatría de un hospital de tercer nivel. Se incluyó a todos los pacientes mayores de 80 años que ingresaron en la unidad de geriatría y se excluyó a los pacientes subsidiarios de cuidados paliativos y los reingresos. Se recogió la medicación domiciliaria y la previa al episodio de delirium si la había, así como los datos de sexo, edad, presencia de demencia, enfermedad renal crónica, diabetes mellitus, déficit visual, auditivo y su variable combinada déficit sensorial, el historial de caídas previas, ictus, tumor cerebral y delirium prevalente e incidente. Resultados. Se incluyó a 72 pacientes, con un 8,1% de delirium incidente y un 40,9% de delirium prevalente. Se estableció una relación significativa entre la toma de fármacos anticolinérgicos y el delirium incidente según la escala ARS (p = 0,017). Ninguna de las escalas logró establecer una relación con delirium prevalente. Conclusiones. La escala ARS mostró sensibilidad a la predicción del delirium incidente. Todas las escalas fueron insuficientes a la hora de establecer una relación con el delirium prevalente (AU)

Background. The use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium. Methods. An ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital. All patients over 80 years-old were included, except re-admissions or those subjected to palliative care. The data collected included sex, age, chronic medication and any recent changes, recent drugs prescribed prior to an episode of delirium, chronic kidney disease, diabetes mellitus, dementia, visual and auditory impairment, and their combination as sensory impairment, previous falls, stroke, brain tumour, and incident and prevalent delirium. Results. A total of 72 patients were included. Incident delirium was detected in 8.1% of the patients, and prevalent delirium in 40.9%. A statistically significant association was established between anticholinergic drugs and the incident delirium measured by the ARS scale (P=.017). None of the scales was able to establish a significant association with prevalent delirium. Conclusion. The ARS scale was related to new episodes of delirium. All scales were insufficient when it came to establishing an association with prevalent delirium (AU)

[Anticholinergic burden and delirium in elderly patients during acute hospital admission]. / Carga anticolinérgica y delirium en pacientes mayores durante la hospitalización en una unidad de agudos de geriatría.

BACKGROUND: The use of anticholinergic drugs in the elderly has been associated to an increased frequency of delirium. There are different scales for estimating the anticholinergic burden, such as the Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and Anticholinergic Cognitive Burden (ACB). The aim of the study is to establish the relationship between anticholinergic burden measured by ADS, ARS, and ACB scales and incident or prevalent delirium. METHODS: An ambispective observational study was conducted for 76 days in the acute geriatric unit of a tertiary hospital. All patients over 80 years-old were included, except re-admissions or those subjected to palliative care. The data collected included sex, age, chronic medication and any recent changes, recent drugs prescribed prior to an episode of delirium, chronic kidney disease, diabetes mellitus, dementia, visual and auditory impairment, and their combination as sensory impairment, previous falls, stroke, brain tumour, and incident and prevalent delirium. RESULTS: A total of 72 patients were included. Incident delirium was detected in 8.1% of the patients, and prevalent delirium in 40.9%. A statistically significant association was established between anticholinergic drugs and the incident delirium measured by the ARS scale (P=.017). None of the scales was able to establish a significant association with prevalent delirium. CONCLUSION: The ARS scale was related to new episodes of delirium. All scales were insufficient when it came to establishing an association with prevalent delirium.