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Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B

Nicole M Bohm1, Katherine C Hoover2, Amy E Wahlquist3

  • 1Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina, Charleston, South Carolina, USA bohm@musc.edu.

Antimicrobial Agents and Chemotherapy
|August 19, 2015
PubMed

Insights

Liposomal amphotericin B can cause falsely high phosphorus levels (pseudohyperphosphatemia) when used with the Beckman Coulter PHOSm assay. This underrecognized interaction requires cautious interpretation of phosphorus results in patients on this antifungal.

Area of Science:

  • Clinical Chemistry
  • Pharmacology
  • Mycology

Background:

  • Pseudohyperphosphatemia is a potential laboratory artifact.
  • Liposomal amphotericin B is a widely used antifungal agent.
  • The Beckman Coulter PHOSm assay is a common method for measuring serum phosphorus.

Purpose of the Study:

  • To compare the incidence of hyperphosphatemia between liposomal amphotericin B and triazole antifungal therapies.
  • To investigate the occurrence of pseudohyperphosphatemia due to liposomal amphotericin B.
  • To describe a case series of patients with confirmed pseudohyperphosphatemia.

Main Methods:

  • Retrospective case-control study.
  • Comparison of hyperphosphatemia incidence in adult inpatients exposed to liposomal amphotericin B versus triazoles.
  • Analysis of patient data stratified by chronic kidney disease and acute kidney injury status.
  • Confirmatory phosphorus testing using an endpoint-based assay for suspected pseudohyperphosphatemia.

Main Results:

  • Hyperphosphatemia occurred significantly more often during liposomal amphotericin B therapy compared to triazole therapy in patients without kidney injury (40% vs 10%) and with chronic kidney disease (59% vs 20%).
  • No significant difference in hyperphosphatemia frequency was observed when acute kidney injury was present during antifungal exposure.
  • Confirmatory testing revealed that pseudohyperphosphatemia led to falsely elevated phosphorus levels, with a median difference of 2.5 mg/dL.

Conclusions:

  • Liposomal amphotericin B exposure is associated with a higher likelihood of developing hyperphosphatemia, likely due to pseudohyperphosphatemia caused by interaction with the Beckman Coulter PHOSm assay.
  • Elevated phosphorus levels in patients receiving liposomal amphotericin B should be interpreted with caution, especially when using the PHOSm assay.
  • Clinicians should be aware of this potential laboratory artifact to avoid misdiagnosis and inappropriate patient management.

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