Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function

• Published in: Nephrology, dialysis, transplantation Vol. 27; no. 1; pp. 381 - 387
• Main Authors: BADVE, Sunil V, HAWLEY, Carmel M, MCDONALD, Stephen P, BROWN, Fiona G, BOUDVILLE, Neil C, WIGGINS, Kathryn J, BANNISTER, Kym M, JOHNSON, David W
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 2012
• Subjects: Aminoglycosides - therapeutic use; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacteremia - drug therapy; Bacteremia - etiology; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Intensive care medicine; Kidney - drug effects; Kidney - physiopathology; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Peritoneal Dialysis - adverse effects; Peritonitis - drug therapy; Peritonitis - etiology; Prognosis; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Kidney disease; Urinary system disease; Renal function; residual renal function; Hemodialysis; Terminal stage; Peritoneal dialysis; Extrarenal dialysis; end-stage kidney disease; Abdominal disease; Aminoglycoside; Renal failure; aminoglycosides; Protein synthesis inhibitor; Peritonitis
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfr274

Aminoglycosides offer several potential benefits in their treatment of peritoneal dialysis (PD)-associated peritonitis, including low cost, activity against Gram-negative organisms (including Pseudomonas aeruginosa), synergistic bactericidal activity against some Gram-positive organisms (such as Staphylococci) and relatively low propensity to promote antimicrobial resistance. However, there is limited conflicting evidence that aminoglycosides may accelerate loss of residual renal function (RRF) in PD patients. The aim of this study was to study the effect of aminoglycoside use on slope of decline in RRF.
The study included 2715 Australian patients receiving PD between October 2003 and December 2007 in whom at least two measurements of renal creatinine clearance were available. Patients were divided according to tertiles of slope of RRF decline (rapid, intermediate and slow). The primary outcome was the slope of RRF over time in patients who received aminoglycosides for PD peritonitis versus those who did not.
A total of 1412 patients (52%) experienced at least one episode of PD peritonitis. An aminoglycoside was used as the initial empiric antibiotic in 1075 patients. The slopes of RRF decline were similar in patients treated and not treated with at least one course of aminoglycoside (median [interquartile range] -0.26 [-1.17 to 0.04] mL/min/1.73 m(2)/month versus -0.22 [-1.11 to 0.01] mL/min/1.73 m(2)/month, P = 0.9). The slopes of RRF decline were also similar in patients receiving repeated courses of aminoglycoside.
Empiric treatment with aminoglycoside for peritonitis was not associated with an adverse effect on RRF in PD patients.