No Increased Acute Kidney Injury Rate Through Giving an Intravenous Colistin Loading Dose in Pediatric Patients.

Abstract Objectives Colistin loading dose is required to achieve adequate drug exposure for the treatment of multidrug-resistant Gram-negative bacteria. However, data on acute kidney injury (AKI) rate associated with this approach in children is unknown.We aimed to study the AKI rates in children who were prescribed a colistin loading dose. Methods A retrospective study was conducted in patients aged 1 month to 18 years and receiving intravenous colistin for ≥48 hours. Loading dose (LD) was defined as colistin methanesulfonate of 4–5 mg of colistin base activity/kg/dose. AKI was defined regarding KDIGO serum creatinine (SCr) criteria: SCr ≥1.5 times of the baseline during 3–7 days interval after colistin initiation. Augmented renal clearance (ARC) was defined as estimated eGFR >150 mL/min/1.73 m2. The rates of AKI were compared between children receiving or not receiving an LD, and between different eGFR groups. Results One hundred eighty―one children were enrolled. The mean age was 4.3 years (95% confidence interval (CI), 3.6-4.9 years). Ninety―five (52.5%) were male. There were 157 children with baseline eGFR of ≥80 mL/min/1.73 m2. The overall AKI rate within the first week in this group was 20.4% (95% CI, 14.4―27.6%): LD, 16.1% vs no LD, 23.2%, P =  0.29. Subgroup analysis excluding patients with ARC showed lower AKI rate of 12.8% (95% CI, 6.8-21.3%): LD, 9.7% vs no LD, 14.3%, P =  0.53. Conclusions AKI rate was not different among children who received an intravenous colistin loading dose. This approach should be implemented to ensuring drug exposure which is necessary for good treatment outcomes.