Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11466
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
Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.
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.
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.
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.
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.
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.