The evaluation of frequency of nephrotoxicity caused by liposomal amphotericin B

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Liposomal amphotericin B (L-AmB) was developed to mitigate the nephrotoxicity associated with conventional amphotericin B.
• Limited data exist on L-AmB safety in patients with varying degrees of renal function.
• This study retrospectively assessed L-AmB's clinical safety across different renal function levels.

Purpose of the Study:

• To evaluate the safety profile of liposomal amphotericin B (L-AmB) in patients with diverse renal function statuses.
• To compare the incidence of nephrotoxicity and changes in serum creatinine levels among patient groups with different estimated glomerular filtration rates (eGFR) and those on hemodialysis.

Main Methods:

• Patients receiving L-AmB between April 2014 and September 2016 were categorized into four groups based on eGFR (≥60, 60-30, <30) and hemodialysis.
• The primary outcomes measured were the incidence of nephrotoxicity and the difference in serum creatinine from baseline at the end of L-AmB treatment.

Main Results:

• No significant differences in nephrotoxicity incidence were observed across the four groups (eGFR≥60: 27.0%, 60-30: 30.8%, <30: 50.0%, hemodialysis: 40.0%, p=0.56).
• A significant increase in serum creatinine was noted only in the eGFR≥60 group post-L-AmB initiation (p<0.01).
• The time to a ≥0.5 mg/dL increase in serum creatinine was similar across groups, with a median of 4.5-5.5 days.

Conclusions:

• Liposomal amphotericin B (L-AmB) appears to be a safer alternative to conventional amphotericin B for treating fungal infections in patients with eGFR<60 and those on hemodialysis.
• Close monitoring of L-AmB therapy is particularly recommended during the first 9 days of treatment, irrespective of renal function.