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- Title
N-ACETYLCYSTEINE PREVENTS COLISTIN-INDUCED NEPHROTOXICITY IN CRITICALLY ILL PATIENTS.
- Authors
Taşkın, Gürhan; Acar, Ramazan
- Abstract
Objective: Colistimethate sodium (CMS) is a well known nephrotoxic agent. But, there is no proven therapy in CMS-induced nephrotoxicity yet. It has been shown that N-acetylcysteine (NAC) has renal protective effects in various settings. We aimed to evaluate incidence and risk factors for nephrotoxicity in critically ill patients who have use CMS and investigate whether there is a renal protective role of NAC therapy. Materials-Methods: In this retrospective study, we reviewed patients' medical records who admitted to our 24-bed medical Intensive Care Unit between 01 January 2012 and 01 January 2017. Patients who prescribed renal replacement therapy (RRT) due to any reason before CMS therapy, individuals under the age of 18 years or above the age of 90, and patients treated with CMS for less than 48 hours were excluded. Patients who received CMS therapy were divided into two groups according to the development of nephrotoxicity. Additionally, patients who had CMSinduced nephrotoxicity were also divided into two groups according to the renal replacement therapy (RRT) requirement. In both groups, we analyzed the effect of NAC treatment on the prevention of nephrotoxicity and RRT requirement. Results: One hundred and twenty-four patients met the enrollment criteria of our study. Seventeen patients excluded. The remaining one hundred and seven patients were included in the study.Nephrotoxicity, as defined by the RIFLE criteria, seen in 56 (52.3%) patients and 20 (35.7%) of them were prescribed RRT. Advanced age (p=.001), presence of chronic obstructive pulmonary disease (COPD) (p=.027), need for mechanical ventilation (MV) (p=.023) and absence of concomitant NAC therapy (p=.003) were identified as independent risk factors for nephrotoxicity. Receiving concomitant NAC therapy was also associated with the decreased nephrotoxicity (p=.001) and also significantly decreased the requirement of RRT (p=.003). Concomitant use of NAC therapy was provided a 6.4-fold risk reduction in the need for RRT. Conclusion: Advanced age, presence of COPD, and receiving MV in ICU patients are an independent risk factors for CMS-induced nephrotoxicity. NAC administration may reduce the risk of both the developing nephrotoxicity and need for RRT.
- Subjects
TURKEY; CONFERENCES &; conventions; CRITICALLY ill; NEPHROTOXICOLOGY; PATIENTS; ACETYLCYSTEINE; COLISTIN
- Publication
Turkish Journal of Medical & Surgical Intensive Care Medicine / Dahili ve Cerrahi Yoğun Bakım Dergisi, 2019, Vol 10, pS62
- ISSN
1309-1689
- Publication type
Article