Colistin-Induced Chronic Kidney Disease

Antibiotics were true life-savers when they became widely available after 1945. Almost criminal overuse and misuse of these medications has led to the rapid emergence of resistant bacteria is occurring worldwide. Many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat.

What happens if all other antibiotics fail, you might ask. The answer is that doctors are forced to use colistin, a decades-old drug that fell out of favor in human medicine due to its kidney toxicity. However, it remains one of the last-resort antibiotics for some types multidrug-resistant bacteria.

Colistin is a nephrotoxic antibiotic. Nephrotoxicity is the concerning adverse effect of this drug. The mechanism of nephrotoxicity is via an increase in tubular epithelial cell membrane permeability, which results in cation, anion and water influx leading to cell swelling and cell lysis. There are also some oxidative and inflammatory pathways that seem to be involved in colistin nephrotoxicity. Risk factors of colistin nephrotoxicity can be categorized as dose and duration of colistin therapy, co-administration of other nephrotoxic drugs and patient-related factors such as age, sex, hypoalbuminemia, hyperbilirubinemia, underlying disease and severity of patient illness[1]. Another viewpoint says that periodic assessment of serum creatinine levels, modification of the colistin dose according to renal function, avoidance of coadministration of other nephrotoxic agents (if possible), shortening the duration of antimicrobial treatment, and attention to overall patient care, including hydration status, will minimize the potential for nephrotoxic effects of this valuable old antibiotic[2].

I would like to propose the term Colistin-Induced Chronic Kidney Disease for this specific Chronic Kidney Disease.

But we cannot win the arms race with nature, because animals and humans are finding ways to circumvent colistin and several MCR (Mobilized Colistin Resistance) genes have been reported since 2015 in all corners of the world.

[1] Ordooei Javan et al: A review on colistin nephrotoxicity in European Journal of Clinical Pharmacology – 2015
[2] Falagas, Rafailidis: Nephrotoxicity of Colistin: New Insight into an Old Antibiotic in Clinical Infectious Diseases - 2009