Objective To investigate the risk factors of colistin sulfate associated acute kidney injury (AKI) and to evaluate the relationship between steady state trough concentration (C_min) of colistin sulfate and its nephrotoxicity.

Methods A retrospective analysis of pathophysiological data of patients with carbapenem-resistant Gram-negative bacteria treated with colistin sulfate at Beijing Electric Power Hospital of State Grid Corporation of China from January 2021 to January 2024 was conducted. Univariate analysis and multivariate Logistic regression were used to identify risk factors for colistin sulfate associated AKI.

Results A total of 96 patients were enrolled in this study. AKI was detected in 20 patients (20.84%) during and 8 (8.33%) patients after colistin sulfate treatment. Logistic regression analysis showed that the concomitant use of nephrotoxic drug [OR=10.33, 95%CI (1.28, 1,340.43)], steady C_min [OR=11.04, 95%CI (2.60, 46.89)] and the treatment duration of colistin sulfate at the highest creatinine level [OR=1.15, 95%CI (1.03, 1.29)] were independent risk factors for AKI during colistin sulfate treatment.

Conclusion The steady C_min is the main factor influencing colistin sulfate associated AKI, which should be paid attention on clinical practice. Timely therapeutic drug concentration monitoring is recommended to provide a reference for predicting and preventing the occurrence of AKI during colistin sulfate therapy.

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