Clinical and Experimental Nephrology

, Volume 22, Issue 3, pp 613–619 | Cite as

Risk factors of ceftriaxone-associated biliary pseudolithiasis in adults: influence of renal dysfunction

  • Aya Imafuku
  • Naoki Sawa
  • Akinari Sekine
  • Masahiro Kawada
  • Rikako Hiramatsu
  • Masayuki Yamanouchi
  • Eiko Hasegawa
  • Noriko Hayami
  • Jyunichi Hoshino
  • Yoshifumi Ubara
  • Kenmei Takaichi
Original article



Ceftriaxone (CTRX) is a known cause of biliary pseudolithiasis (BPL) mainly in children. Biliary elimination of CTRX increases in patients with renal dysfunction. However, the influence of renal dysfunction on the incidence of CTRX-associated BPL has not been well investigated. The aim of this study was to investigate the cumulative incidence of CTRX-associated BPL in adults and to assess if renal dysfunction is a risk factor.


We retrospectively analyzed the medical records of 478 patients treated with CTRX to assess the incidence and risk factors of CTRX-associated BPL. We examined age, sex, body weight, dosage, and duration of CTRX therapy, and the concentrations of serum creatinine, estimated glomerular filtration rate (eGFR), albumin, and serum calcium in all the patients. The cumulative incidence of BPL was calculated using a competing risk model. The multivariate analysis of each variable for the development of BPL was assessed by a Cox proportional hazards model.


A total of 362 patients (75.7%) had renal dysfunction (eGFR: < 60 mL/min). The cumulative incidence of BPL in patients with renal dysfunction was significantly higher than that in patients with normal kidney function (4.1 vs. 0.6%, p = 0.017). Renal dysfunction (Hazard ratio (HR) 8.14, 95% CI 1.05–63.0, p = 0.045) and female sex (HR 5.35, 95% CI 1.17–24.5, p = 0.031) were independent risk factors of CTRX-associated BPL, which was confirmed using multivariate analysis (renal dysfunction: HR 7.93, 95% CI 1.04–60.5, p = 0.046) (female sex HR 4.65, 95% CI 1.03–21.1, p = 0.046).


Renal dysfunction is an independent risk factor of CTRX-associated BPL in adults.


Ceftriaxone-associated biliary pseudolithiasis Kidney dysfunction Infection 



This study was funded by the Okinaka Memorial Institute for Medical Research.

Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB Approval Number 994) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Japanese Society of Nephrology 2017

Authors and Affiliations

  • Aya Imafuku
    • 1
  • Naoki Sawa
    • 1
    • 2
  • Akinari Sekine
    • 1
  • Masahiro Kawada
    • 1
  • Rikako Hiramatsu
    • 1
  • Masayuki Yamanouchi
    • 1
  • Eiko Hasegawa
    • 1
  • Noriko Hayami
    • 1
  • Jyunichi Hoshino
    • 1
  • Yoshifumi Ubara
    • 1
  • Kenmei Takaichi
    • 1
  1. 1.Department of Nephrology CenterToranomon HospitalMinatokuJapan
  2. 2.Okinaka Memorial Institute for Medical ResearchMinatokuJapan

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