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However, polymyxin-associated acute kidney injury (PA-AKI) remains a major factor limiting their clinical application. This review examines the pathophysiology, risk factors and clinical management of PA-AKI, providing updated perspectives on its prevention and treatment. Reducing exposure to concomitant nephrotoxic agents, together with timely and standardized monitoring of serum creatinine, urine volume and polymyxin concentrations, plays a key role in mitigating the risk and progression of PA-AKI. Although several biomarkers show promise for the early prediction of PA-AKI and may enable earlier intervention, many have not yet undergone extensive clinical validation. There is a clear need to incorporate real-world evidence into clinical practice guidelines for polymyxin use. Further research should focus on identifying genetic risk factors for PA-AKI and developing novel polymyxin analogues with reduced nephrotoxicity.<\/jats:p>","DOI":"10.1093\/jac\/dkag132","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T11:32:00Z","timestamp":1774956720000},"source":"Crossref","is-referenced-by-count":1,"title":["Pathophysiology, risk factors and clinical management for polymyxin-associated acute kidney injury"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2406-9104","authenticated-orcid":false,"given":"Simiao","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Peking University First Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyan","family":"Mu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Peking University First Hospital , Beijing 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of Education of China , Beijing ,","place":["China"]},{"name":"Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences , Beijing ,","place":["China"]},{"name":"Beijing Key Laboratory of Precision Medicine and New-Drug\/Equipment Development for Severe Kidney Disease , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2562-8323","authenticated-orcid":false,"given":"Ying","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Peking University First Hospital , Beijing ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"2026041702462570100_dkag132-B1","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/s41572-021-00284-z","article-title":"Acute kidney 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