High Frequency of Linezolid-Associated Thrombocytopenia and Anemia among Patients with End-Stage Renal Disease

BACKGROUND: Data about the efficacy and tolerability of linezolid for the treatment of gram-positive bacterial infections in patients with end- stage renal disease (ESRD) are lacking. METHODS: This retrospective case- control study compared the tolerability and efficacy of linezolid therapy for patients with ESRD and patients with non-end-stage renal disease ( NESRD), all of whom had gram-positive bacterial infections. RESULTS: There were 58 men and 33 women enrolled in the study, with a mean age of 61.5 years (range, 45.4-81 .2 years). Among these patients, 28 (30.8%) were receiving hemodialysis at the start of linezolid treatment. The ESRD group had a higher percentage of patients with diabetes mellitus (57.1% vs. 33. 3%; P = .029) and an older mean age ( +/-SD) (72.1 +/- 10.8 years vs. 56.8 +/- 20.4 years; P < . 001), compared with the NESRD group. Severe thrombocytopenia (platelet count, < 100 x 10(9) platelets/L) and anemia were significantly more frequent in the ESRD group, compared with the NESRD group (78.6% vs. 42.9% [P = .003] and 71.4% vs. 36.5% [P = .003], respectively). The independent risk factors for thrombocytopenia identified by logistic regression analysis were pretreatment disease severity score (odds ratio [OR], 1.34; 95%, confidence interval [CI], 1.13 - 1.60; P = .001), central catheter-related infection (OR, 4. 96; 95% CI, 1.08-22.73; P = .046), and ESRD (OR, 6.14; 95% CI, 1.63-23.26; P = .007). ESRD was the only independent risk factor for anemia (OR, 4; 95% CI, 1.50- 10.64; P = .006) . Survival analysis for the development of thrombocytopenia or death showed significant differences between patients with ESRD and patients with NESRD (P < .001). CONCLUSIONS: The lower tolerability of linezolid in patients with ESRD, compared with those with NESRD, is evidenced by the higher rates of thrombocytopenia and anemia in the former group. The severity of these conditions necessitates treatment discontinuation for patients with ESRD more often than for patients with NESRD