Ceftriaxone-associated pseudolithiasis in hemodialysis patients: a case series study

Background Ceftriaxone, a third-generation cephalosporin, is widely used to treat bacterial infections in patients undergoing dialysis because it has a long half-life and broad spectrum of action and does not require dose reduction. However, renal dysfunction is a risk factor for ceftriaxone-associated pseudolithiasis that has rarely been reported in patients undergoing hemodialysis. This study aimed to present the detailed clinical manifestations of, and susceptibility to, ceftriaxone-associated pseudolithiasis in hemodialysis patients. Methods Seventy-seven hemodialysis patients received ceftriaxone between February 2011 and June 2019, and 33 patients underwent abdominal computed tomography within 1 year of receiving the drug. Among these 33 patients, 11 have developed ceftriaxone-associated pseudolithiasis. We retrospectively reviewed these patients’ medical records. We also compared the medical records of ten patients who underwent computed tomography scans within 60 days of ceftriaxone administration and developed ceftriaxone-associated pseudolithiasis with those of patients who did not develop this adverse event. Results Pseudolithiasis tended to develop when patients received ceftriaxone for longer periods or at a higher total dosage. However, the ceftriaxone dose and the disease severity were not significantly correlated. Most patients improved within several months; however, the condition persisted for 10 months in a patient with a spinal cord injury. There were no significant differences in patient characteristics, prevalence of diabetes mellitus or cerebrovascular disease, being bed-bound, fasting, serum albumin, calcium, intact parathormone, or dose per unit body mass between the two groups. However, patients who developed pseudolithiasis had received ceftriaxone for significantly longer and at a higher total dose than those who did not develop pseudolithiasis (12 days; interquartile range [IQ], 8.3–14 vs. 4 days, IQ, 2–8, P = 0.00872; 12.5 g, IQ, 9.3–14 vs. 4 g, IQ, 2–8, P = 0.00476, respectively). Conclusions Ceftriaxone-associated pseudolithiasis may be relatively common in patients undergoing hemodialysis, especially in those who receive a higher total quantity of drug or for a longer duration. It is important to be aware of the possibility of pseudolithiasis developing in hemodialysis patients who receive ceftriaxone. These patients should be monitored during, and for up to 1 year after, its administration.