Effect of continuous renal replacement therapy on plasma concentration, clinical efficacy and safety of colistin sulfate
10.3760/cma.j.cn121430-20220906-00819
- VernacularTitle:连续性肾脏替代治疗对硫酸黏菌素血药浓度和临床疗效及安全性的影响
- Author:
Danyang PENG
1
;
Fan ZHANG
;
Zhaozhen LI
;
Pin LYU
;
Ziqi GUO
;
Yinyin CHEN
;
Jingge ZHAO
;
Jingjing NIU
;
Bo GUO
;
Wenqing JIA
;
Xiaofeng JIANG
;
Xiaozhao LI
;
Shaoyan QI
;
Bingyu QIN
;
Huanzhang SHAO
Author Information
1. 河南大学人民医院重症医学科，郑州 450003
- Keywords:
Colistin sulfate;
Plasma concentration;
Continuous renal replacement therapy;
Clinical efficacy;
Adverse reaction
- From:
Chinese Critical Care Medicine
2023;35(1):88-92
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effects of continuous renal replacement therapy (CRRT) on plasma concentration, clinical efficacy and safety of colistin sulfate.Methods:Clinical data of patients received with colistin sulfate were retrospectively analyzed from our group's previous clinical registration study, which was a prospective, multicenter observation study on the efficacy and pharmacokinetic characteristics of colistin sulfate in patients with severe infection in intensive care unit (ICU). According to whether patients received blood purification treatment, they were divided into CRRT group and non-CRRT group. Baseline data (gender, age, whether complicated with diabetes, chronic nervous system disease, etc), general data (infection of pathogens and sites, steady-state trough concentration, steady-state peak concentration, clinical efficacy, 28-day all-cause mortality, etc) and adverse event (renal injury, nervous system, skin pigmentation, etc) were collected from the two groups.Results:A total of 90 patients were enrolled, including 22 patients in the CRRT group and 68 patients in the non-CRRT group. ① There was no significant difference in gender, age, basic diseases, liver function, infection of pathogens and sites, colistin sulfate dose between the two groups. Compared with the non-CRRT group, the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) were higher in the CRRT group [APACHE Ⅱ: 21.77±8.26 vs. 18.01±6.34, P < 0.05; SOFA: 8.5 (7.8, 11.0) vs. 6.0 (4.0, 9.0), P < 0.01], serum creatinine level was higher [μmol/L: 162.0 (119.5, 210.5) vs. 72.0 (52.0, 117.0), P < 0.01]. ② Plasma concentration: there was no significant difference in steady-state trough concentration between CRRT group and non-CRRT group (mg/L: 0.58±0.30 vs. 0.64±0.25, P = 0.328), nor was there significant difference in steady-state peak concentration (mg/L: 1.02±0.37 vs. 1.18±0.45, P = 0.133). ③ Clinical efficacy: there was no significant difference in clinical response rate between CRRT group and non-CRRT group [68.2% (15/22) vs. 80.9% (55/68), P = 0.213]. ④ Safety: acute kidney injury occurred in 2 patients (2.9%) in the non-CRRT group. No obvious neurological symptoms and skin pigmentation were found in the two groups. Conclusions:CRRT had little effect on the elimination of colistin sulfate. Routine blood concentration monitoring (TDM) is warranted in patients received with CRRT.
