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Michael Behal, PharmD
University of Kentucky
Lexington, Kentucky
Disclosure information not submitted.
Jonny Nguyen, PharmD, MBA
Pharmacy Resident
University of Kentucky College of Pharmacy, United States
Disclosure information not submitted.
Xilong Li, PhD, MBA
Data Scientist
University of Texas Southwestern Medical Center, United States
Disclosure information not submitted.
David Feola, PharmD, PhD
Associate Professor
University of Kentucky College of Pharmacy, United States
Disclosure information not submitted.
Javier Neyra, MD, MSCS
Associate Professor
University of Kentucky College of Medicine, United States
Disclosure information not submitted.
Alexander Flannery, PharmD, PhD, BCCCP
Assistant Professor
University of Kentucky College of Pharmacy
Lexington, Kentucky
Disclosure information not submitted.
Title: Azithromycin and Major Adverse Kidney Events in Critically Ill Patients with Sepsis-Associated AKI
Introduction:
Sepsis is a leading cause of acute kidney injury (AKI). Macrophages contribute to inflammatory response in sepsis-associated-AKI, and macrolide antibiotics promote macrophage polarization to an anti-inflammatory phenotype. The aim of this study was to determine the effect of azithromycin on Major Adverse Kidney Events (MAKE) in critically ill patients with sepsis-associated-AKI.
Methods:
This was a single-center, retrospective cohort study of adult patients with SA-AKI admitted to the medical intensive care unit (ICU) in a tertiary care hospital. We compared outcomes according to exposure to azithromycin, defined as administration of azithromycin within 48-hours of ICU admission. The primary outcome was the composite outcome MAKE at discharge (death, need for kidney replacement therapy, or 25% decrease in estimated glomerular filtration rate from baseline). Sensitivity analyses and an E-value test were also conducted.
Results:
Seven-hundred and thirty-seven patients were included, and 152 (20.6%) received azithromycin. Patients receiving azithromycin were less likely to experience MAKE at discharge when compared to those without the exposure (59/152 (38.8%) vs. 283/585 (48.4%), p=0.035). In multivariable analysis, exposure to azithromycin was independently associated with a decreased risk of MAKE at discharge (aOR 0.62, 95% CI 0.41-0.93, p=0.020). This association remained significant in sensitivity analyses utilizing alternative definitions of MAKE at discharge.
Conclusions:
Our study found that exposure to azithromycin during SA-AKI was independently associated with lower risk of MAKE at discharge. The potential immunomodulatory effects of azithromycin in SA-AKI warrant further investigation.