Azithromycin and Major Adverse Kidney Events in Critically Ill Patients with Sepsis-Associated Acute Kidney Injury

Michael L. Behal, Jonny L. Nguyen, Xilong Li, David J. Feola, Javier A. Neyra, Alexander H. Flannery

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background:Sepsis-associated acute kidney injury (SA-AKI) is associated with significant morbidity and mortality. Immune dysregulation is a hallmark of sepsis, with important contributions to organ dysfunction including injury and repair mechanisms in AKI. Macrolide antibiotics, such as azithromycin, have previously demonstrated in preclinical models a myriad of immunomodulatory effects that may benefit critically ill patients with SA-AKI. The aim of this study was to determine if early receipt of azithromycin in SA-AKI is associated with a reduction in major adverse kidney events (MAKE) at hospital discharge.Methods:This was a single center, retrospective cohort study of critically ill adult patients with SA-AKI. Early exposure to azithromycin was defined as receipt of one or more doses within 48 h of a hospital admission with SA-AKI. The primary outcome of MAKE assessed at hospital discharge was the composite of death, requirement for kidney replacement therapy, or a decline in estimated glomerular filtration rate of 25% or more. Multivariable logistic regression was used to account for potential confounders in the assessment.Results:Of 737 included patients with SA-AKI, 152 (20.6%) received azithromycin. Patients that received early azithromycin were less likely to experience MAKE at hospital discharge when compared to those patients not receiving azithromycin: 38.8% versus 48.4% (P = 0.035). In multivariable logistic regression, receipt of azithromycin was independently associated with a decreased odds of MAKE at hospital discharge (aOR 0.62, 95% CI 0.41-0.93).Conclusions:Early exposure to azithromycin in SA-AKI is independently associated with lower odds of MAKE at hospital discharge.

Original languageEnglish
Pages (from-to)479-485
Number of pages7
Issue number4
StatePublished - Apr 1 2022

Bibliographical note

Funding Information:
The project described was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.


  • Acute kidney injury
  • azithromycin
  • critical care
  • macrolide
  • major adverse kidney event
  • sepsis

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine


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