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Nephrotoxicity and other adverse events among inpatients receiving liposomal amphotericin B or amphotericin B lipid

Rolin L Wade1, Paresh Chaudhari, Jaime L Natoli

  • 1Cerner Research, Culver City, CA, USA.

Diagnostic Microbiology and Infectious Disease
|June 19, 2013
PubMed

Insights

Liposomal amphotericin B (L-AMB) showed significantly less nephrotoxicity, infusion reactions, and hypomagnesemia compared to amphotericin B lipid complex (ABLC) in high-risk patients with invasive fungal infections.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Pharmacology

Background:

  • Nephrotoxicity of lipid formulations of amphotericin B, including liposomal amphotericin B (L-AMB) and amphotericin B lipid complex (ABLC), has yielded conflicting results.
  • Patients with invasive fungal infections often require amphotericin B, but its nephrotoxic potential necessitates careful evaluation of alternative formulations.

Purpose of the Study:

  • To compare the incidence of nephrotoxicity between L-AMB and ABLC in hospitalized patients with invasive fungal infections.
  • To assess other adverse events, including infusion reactions and hypomagnesemia, associated with L-AMB and ABLC.

Main Methods:

  • Retrospective analysis of electronic medical records for hospitalized patients treated with L-AMB or ABLC.
  • Inclusion criteria comprised patients with renal insufficiency, intolerance to conventional amphotericin B deoxycholate (CAB), or recent CAB exposure.
  • Comparison of nephrotoxicity rates, infusion reactions, and hypomagnesemia between the L-AMB and ABLC groups, with logistic regression analysis.

Main Results:

  • Nephrotoxicity occurred in 10.6% of L-AMB recipients versus 22.6% of ABLC recipients (P = 0.020).
  • Patients receiving ABLC had 3.48 times higher odds of developing nephrotoxicity compared to L-AMB (95% CI 1.05-11.52).
  • Infusion reactions (23.9% vs 9.5%, P = 0.002) and hypomagnesemia (44.3% vs 28.1%, P = 0.033) were more frequent with ABLC.

Conclusions:

  • Liposomal amphotericin B (L-AMB) is associated with a lower incidence of nephrotoxicity compared to amphotericin B lipid complex (ABLC).
  • L-AMB demonstrated a favorable safety profile regarding infusion reactions and hypomagnesemia in patients at increased risk for nephrotoxicity.

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