Risk factors for acute kidney injury in patients treated with polymyxin B at a Tertiary Care Medical Center.

INTRODUCTION: Polimyxins were originally abandoned due to high rates of nephrotoxicity. However they have been recently reintroduced due to activity against carbapenem-resistant Gram-negative organisms. Recent literature suggests a lower rate of nephrotoxicity than historically reported. OBJECTIVE: To determine the rate of polymixins-associated nephrotoxicity as defined by the RIFLE criteria. METHODS: A retrospective cohort of all adult patients who received polymixin B at a terciary hospital from December 2010 to March 2011was performed. RESULTS: 61 patients (43%) fulfilled the RIFLE criteria for renal injury and 28 patients (13.7%) needed dialysis. Independent predictors for nephrotoxicity were hypotension (OR, 2.79; CI 1.14-5.8; p = 0.006) and concomitant use of vancomycin (OR, 2.86; CI, 1.27-6.4; p = 0.011). CONCLUSIONS: In this retrospective cohort, nephrotoxicity (as defined by RIFLE criteria) occurred among 43% of treated patients. The concomitant use of vancomycin and hypotension were independent risk factors of nephropathy. Further studies are needed, particularly with polymyxin B, to clarify if the characteristics of this drug and colistin are overlapping.

Fatores de risco associados à lesão renal aguda em pacientes tratados com polimixina B em um hospital terciário / Risk factors for acute kidney injury in patients treated with polymyxin B at a Tertiary Care Medical Center

Resumo Introdução: O uso de polimixinas foi praticamente abandonado nos anos 1970 devido as altas taxas de nefropatia. Entretanto, foram reintroduzidas na prática médica devido a sua ação contra bactérias gram negativas resistentes a carbapenemicos. A literatura recente sugere uma taxa de nefropatia mais baixa do que a historicamente reportada. Objetivo: Determinar a incidência de nefropatia associada ao uso de polimixina utilizando os critérios de RIFLE. Métodos: Foi realizada coorte retrospectiva de todos pacientes adultos que receberam polimixina B no Hospital Nossa Senhora da Conceição de dezembro de 2010 até março de 2011. Resultados: 61 pacientes (43%) preencheram os critérios de rifle para injúria renal e 28 (13,7%) necessitaram de diálise. Preditores independentes para nefrotoxicidade foram hipotensão (OR, 2.79; CI 1.14-5.8; p = 0.006) e uso concomitante de vancomicina (OR, 2.86; CI, 1.27-6.4; p = 0.011). Conclusão: Nessa coorte retrospectiva, nefrotoxicidade (definida pelos criterios de RIFLE) ocorreu em 43% dos pacientes tratados com polimixina B. O uso concomitante de vancomicina e hipotensão foram fatores de risco independentes para desenvolvimento de nefropatia. Mais estudos são necessarios, particularmente com polimixina B, para esclarecer se as caracteristicas dessa droga e da colistina são sobreponíveis.

Abstract Introduction: Polimyxins were originally abandoned due to high rates of nephrotoxicity. However they have been recently reintroduced due to activity against carbapenem-resistant Gram-negative organisms. Recent literature suggests a lower rate of nephrotoxicity than historically reported. Objective: To determine the rate of polymixins-associated nephrotoxicity as defined by the RIFLE criteria. Methods: A retrospective cohort of all adult patients who received polymixin B at a terciary hospital from December 2010 to March 2011was performed. Results: 61 patients (43%) fulfilled the RIFLE criteria for renal injury and 28 patients (13.7%) needed dialysis. Independent predictors for nephrotoxicity were hypotension (OR, 2.79; CI 1.14-5.8; p = 0.006) and concomitant use of vancomycin (OR, 2.86; CI, 1.27-6.4; p = 0.011). Conclusions: In this retrospective cohort, nephrotoxicity (as defined by RIFLE criteria) occurred among 43% of treated patients. The concomitant use of vancomycin and hypotension were independent risk factors of nephropathy. Further studies are needed, particularly with polymyxin B, to clarify if the characteristics of this drug and colistin are overlapping.

Experimental measurements of the temperature variation along artery-vein pairs from 200 to 1000 microns diameter in rat hind limb.

Theoretical studies have indicated that a significant fraction of all blood-tissue heat transfer occurs in artery-vein pairs whose arterial diameter varies between 200 and 1000 microns. In this study, we have developed a new in vivo technique in which it is possible to make the first direct measurements of the countercurrent thermal equilibration that occurs along thermally significant vessels of this size. Fine wire thermocouples were attached by superglue to the femoral arteries and veins and their subsequent branches in rats and the axial temperature variation in each vessel was measured under different physiological conditions. Unlike the blood vessels < 200 microns in diameter, where the blood rapidly equilibrates with the surrounding tissue, we found that the thermal equilibration length of blood vessels between 200 microns and 1000 microns in diameter is longer than or at least equivalent to the vessel length. It is shown that the axial arterial temperature decays from 44% to 76% of the total core-skin temperature difference along blood vessels of this size, and this decay depends strongly on the local blood perfusion rate and the vascular geometry. Our experimental measurements also showed that the SAV venous blood recaptured up to 41% of the total heat released from its countercurrent artery under normal conditions. The contribution of countercurrent heat exchange is significantly reduced in these larger thermally significant vessels for hyperemic conditions as predicted by previous theoretical analyses. Results from this study, when combined with previous analyses of vessel pairs less than 200 microns diameter, enable one estimate the arterial supply temperature and the correction coefficient in the modified perfusion source term developed by the authors.