Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2022; 10(31): 11466-11485
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11466
Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis
Jiang-Lin Wang, Bi-Xiao Xiang, Xiao-Li Song, Rui-Man Que, Xiao-Cong Zuo, Yue-Liang Xie
Jiang-Lin Wang, Bi-Xiao Xiang, Rui-Man Que, Xiao-Cong Zuo, Yue-Liang Xie, Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
Xiao-Li Song, Department of Pharmacy, Sanya Central Hospital, Sanya 572000, Hainan Province, China
Author contributions: Wang JL acquisition of data, analysis and interpretation of data, drafting the article, final approval; Xiang BX acquisition of data, final approval; Song XL acquisition of data, final approval; Que RM acquisition of data, final approval; Zuo XC critical revision, final approval; Xie YL conception and design of the study, critical revision, final approval.
Supported by The Hunan Province Natural Science Foundation, No. 2022JJ80043; Nature Science Foundation of Changsha, No. kq2014268; Hunan Engineering Research Center of Intelligent Prevention and Control for Drug Induced Organ Injury, No. 40; Scientific Research Fund Project of Hunan Pharmaceutical Society, No. 2020YXH010.
Conflict-of-interest statement: All the authors declare having no conflict of interest related to this work.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist in detail, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue-Liang Xie, PharmD, Pharmacist, Department of Pharmacy, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. xieyliang@csu.edu.cn
Received: August 8, 2022
Peer-review started: August 8, 2022
First decision: September 5, 2022
Revised: September 15, 2022
Accepted: September 23, 2022
Article in press: September 23, 2022
Published online: November 6, 2022
Processing time: 79 Days and 21.5 Hours
Abstract
BACKGROUND

Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.

AIM

To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit (ICU) patients.

METHODS

PubMed, EMBASE, the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30, 2022. The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver. 12.1. Additionally, subgroup analyses and meta-regression were conducted to assess heterogeneity.

RESULTS

A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis. The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%. The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B (PMB)-induced nephrotoxicity. The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval, nephrotoxicity criteria, age, publication year, study quality and sample size, which were confirmed in the univariable meta-regression analysis. Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses. Furthermore, older age, the presence of sepsis or septic shock, hypoalbuminemia, and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity, while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity.

CONCLUSION

Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high. It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.

Keywords: Polymyxins; Nephrotoxicity; Critically ill adult patients; Risk factors; Meta-analysis

Core Tip: Polymyxins have recently been reintroduced as a last-line option in chemotherapy for infections caused by multidrug-resistant gram-negative bacteria. However, these agents can cause nephrotoxicity. Notably, the prevalence of and risk factors for polymyxin-associated nephrotoxicity in adult intensive care unit (ICU) patients remain unclear. This is the first systematic review and meta-analysis to estimate the prevalence of and risk factors for polymyxin-induced nephrotoxicity in adult ICU patients. Based on the data collected and analysed, we conclude that the high incidence of polymyxin-induced nephrotoxicity is a primary safety concern and challenge in clinical practice. The avoidance of modifiable risk factors (such as nephrotoxic drugs and dosage regimens containing polymyxins) in adult ICU patients can likely reduce the risk of polymyxin-induced nephrotoxicity.