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Amikacin nephrotoxicity in patients with chronic liver disease
J Cortés1, G Gamba, A Contreras
1Departamento de Medicina Interna, Instituto Nacional de la Nutrición Salvador Zubirán, México, D.F., México.
Abstract:
Chronic liver disease is a risk factor for aminoglycoside nephrotoxicity. We conducted this study to identify the incidence and risk factors associated with it. A total of 45 patients with liver disease and 329 controls were included, with a toxicity incidence of 17.7%, similar to that in controls. Chronic liver disease patients received lower amikacin doses than calculated on the basis of creatinine clearance (498 +/- 1187 vs 611 = 313 mg/day). Serum albumin, both at the beginning of the treatment and at the end was lower in patients who developed toxicity, and bilirubin levels were higher in these patients at the end of the treatment. Apparently, a dose reduction may lessen the risk for amikacin nephrotoxicity in patients with chronic liver disease. We conclude that hypoalbuminemia and hyperbilirubinemia are risk factors in this complication.
Insights
Patients with chronic liver disease have a similar risk of aminoglycoside nephrotoxicity. Lower amikacin doses may reduce this risk, with hypoalbuminemia and hyperbilirubinemia identified as key risk factors.
Area of Science:
- Nephrology
- Hepatology
- Clinical Pharmacology
Background:
- Chronic liver disease is a recognized risk factor for aminoglycoside-induced kidney damage.
- Understanding the specific incidence and contributing factors is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of aminoglycoside nephrotoxicity in patients with chronic liver disease.
- To identify specific risk factors for this complication in the studied population.
Main Methods:
- A comparative study included 45 patients with chronic liver disease and 329 controls.
- Incidence of nephrotoxicity was recorded and compared between groups.
- Serum albumin and bilirubin levels were analyzed in relation to toxicity development.
Main Results:
- The incidence of nephrotoxicity was 17.7%, comparable between chronic liver disease patients and controls.
- Patients with chronic liver disease received lower amikacin doses than calculated.
- Lower serum albumin and higher serum bilirubin levels were associated with increased toxicity risk.
Conclusions:
- Hypoalbuminemia and hyperbilirubinemia are significant risk factors for aminoglycoside nephrotoxicity in patients with chronic liver disease.
- Dose reduction of amikacin may mitigate the risk of nephrotoxicity in this patient group.