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Risk factors for amphotericin B-induced nephrotoxicity
1University of California, San Francisco, Department of Clinical Pharmacy/School of Pharmacy, 521 Parnassus Avenue, Room C-152, San Francisco, CA 94143-0622, USA.
The Journal of Antimicrobial Chemotherapy
|March 17, 2001
Summary
Amphotericin B can cause kidney damage, with higher doses and other medications increasing risk. Cyclosporine is a key factor in severe cases, but no patients had permanent kidney damage in this study.
Area of Science:
- Nephrology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Amphotericin B is a critical antifungal agent.
- Nephrotoxicity is a known complication of amphotericin B therapy.
- Risk factors for amphotericin B-induced nephrotoxicity require further characterization.
Purpose of the Study:
- To identify risk factors associated with amphotericin B-induced nephrotoxicity.
- To evaluate the incidence of nephrotoxicity using various definitions.
- To inform clinical practice regarding the safe use of amphotericin B.
Main Methods:
- Retrospective review of 178 patients receiving intravenous amphotericin B for >3 days and >100 mg cumulative dose.
- Assessment of nephrotoxicity using five distinct definitions based on serum creatinine changes.
- Multivariate analysis to determine independent risk factors for nephrotoxicity.
Main Results:
- Nephrotoxicity incidence varied by definition, ranging from 8% to 50%.
- Increased cumulative amphotericin B dose and concurrent nephrotoxic drug use were significant risk factors across all definitions.
- Cyclosporine therapy emerged as a strong predictor of severe nephrotoxicity (OR 18.8, P=0.022).
Conclusions:
- Higher cumulative doses of amphotericin B and concomitant nephrotoxic medications increase the risk of kidney injury.
- Cyclosporine use is a significant risk factor for severe amphotericin B-induced nephrotoxicity.
- While amphotericin B can cause transient renal dysfunction, irreversible damage was not observed in this cohort, suggesting careful patient selection and monitoring are key.