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Pentoxifylline in Prevention of Amphotericin B-induced Nephrotoxicity and Electrolyte Abnormalities
Mahsa Panahi-Shokouh1, Azadeh Moghaddas1, Shirinsadat Badri1,2
1Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.
Objective:
Amphotericin B is an antifungal agent used to treat serious fungal infections mainly in critically ill patients. Despite its adverse effects including renal toxicity and electrolyte imbalances, amphotericin B remains one of the best choices for antifungal treatment. Information from animal studies has provided a strong scientific basis for the use of pentoxifylline as lowering nephroprotective agent. The present study was designed to evaluate the efficacy of pentoxifylline in preventing renal toxicity and electrolytes imbalances induced by amphotericin B.
Methods:
This study was conducted as a randomized controlled trial on 44 patients admitted to Sayyedoshohada Hospital, Isfahan, Iran, from October 2016 to August 2018. Patients were assigned to one of the two groups: Pentoxifylline, 400 mg twice a day, or matching placebo, from the 1st day of amphotericin B therapy till minimum of 7 days. All patients' information including lab data (serum and urine levels of Mg, Na, and K, serum creatinine level, blood urea nitrogen [BUN] and urinary creatinine excretion) were gathered at the time of drug initiation and during the study period. The results were analyzed by SPSS v. 20 software and Repeated measures test was used to assess the differences between groups.
Findings:
This study did not show any significant differences between the two groups in terms of all the assessed variables, including serum and urinary levels of electrolytes, and creatinine, as well as the number of cases presented acute kidney injury during the study period.
Conclusion:
Despite the positive effects of pentoxifylline in preventing renal complications in previous studies, this study could not show a definitive result in salt wasting or renal damage induced by amphotericin B. So, Designing robust studies with more included samples would be valuable.
Insights
Pentoxifylline did not prevent kidney damage or electrolyte imbalances caused by amphotericin B in critically ill patients. Further research with larger sample sizes is needed to confirm these findings.
Area of Science:
- Nephrology
- Pharmacology
- Infectious Diseases
Background:
- Amphotericin B is crucial for serious fungal infections but causes renal toxicity and electrolyte imbalances.
- Animal studies suggest pentoxifylline may protect kidneys.
- This study investigated pentoxifylline's nephroprotective effects against amphotericin B.
Purpose of the Study:
- To evaluate pentoxifylline's efficacy in preventing amphotericin B-induced renal toxicity.
- To assess its impact on electrolyte imbalances (Mg, Na, K) and kidney function markers (creatinine, BUN).
Main Methods:
- A randomized controlled trial involving 44 patients receiving amphotericin B.
- Patients were assigned to pentoxifylline (400 mg twice daily) or placebo for at least 7 days.
- Serum/urine electrolytes, creatinine, and BUN were monitored throughout the study.
Main Results:
- No significant differences were observed between the pentoxifylline and placebo groups.
- Assessed variables included serum/urine electrolytes, creatinine levels, and acute kidney injury incidence.
- Pentoxifylline did not demonstrate a protective effect against amphotericin B-induced renal complications.
Conclusions:
- This study found no definitive benefit of pentoxifylline in preventing amphotericin B-induced renal damage or electrolyte disturbances.
- Results contrast with previous animal studies, highlighting the need for more robust clinical trials.
- Larger sample sizes are recommended for future research on pentoxifylline's nephroprotective potential.
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