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A Real-World Data Observational Analysis of the Impact of Liposomal Amphotericin B on Renal Function Using Machine
Ignasi Sacanella1, Erika Esteve-Pitarch1, Jessica Guevara-Chaux2,3
1Department of Pharmacy, Hospital Universitari Joan XXIII, 43005 Tarragona, Spain.
Background:
Liposomal amphotericin B (L-AmB) has become the mainstay of treatment for severe invasive fungal infections. However, the potential for renal toxicity must be considered.
Aims:
To evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more than 48 h.
Methods:
Retrospective, observational, single-center study. Clinical, demographic and laboratory variables were obtained automatically from the electronic medical record. AKI incidence was analyzed in the entire population and in patients with a "low" or "high" risk of AKI based on their creatinine levels at the outset of the study. Factors associated with the development of AKI were studied using random forest models.
Results:
Finally, 67 patients with a median age of 61 (53-71) years, 67% male, a median SOFA of 4 (3-6.5) and a crude mortality of 34.3% were included. No variations in serum creatinine were observed during the observation period, except for a decrease in the high-risk subgroup. A total of 26.8% (total population), 25% (low risk) and 13% (high risk) of patients developed AKI. Norepinephrine, the SOFA score, furosemide (general model), potassium, C-reactive protein and procalcitonin (low-risk subgroup) were the variables identified by the random forest models as important contributing factors to the development of AKI other than L-AmB administration.
Conclusions:
The development of AKI is multifactorial and the administration of L-AmB appears to be safe in this group of patients.
Insights
Liposomal amphotericin B (L-AmB) use in critically ill patients did not show increased acute kidney injury (AKI). L-AmB appears safe, with AKI development being multifactorial.
Area of Science:
- Nephrology
- Critical Care Medicine
- Infectious Diseases
Background:
- Liposomal amphotericin B (L-AmB) is a primary treatment for severe invasive fungal infections.
- Potential renal toxicity of L-AmB necessitates careful monitoring.
Purpose of the Study:
- To assess the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for over 48 hours.
- To identify factors contributing to AKI development in this patient cohort.
Main Methods:
- Retrospective, observational, single-center study design.
- Data extracted from electronic medical records, including clinical, demographic, and laboratory variables.
- AKI incidence analyzed across the total population and stratified by baseline creatinine risk (low/high).
- Random forest models employed to identify factors associated with AKI.
Main Results:
- 67 critically ill patients included (median age 61, 67% male, median SOFA 4).
- Overall AKI incidence was 26.8% (low risk: 25%, high risk: 13%).
- No significant serum creatinine changes observed, with a decrease in the high-risk subgroup.
- Norepinephrine, SOFA score, furosemide, potassium, C-reactive protein, and procalcitonin identified as AKI contributors.
Conclusions:
- Acute kidney injury development in patients receiving L-AmB is multifactorial.
- L-AmB administration appears safe in critically ill patients regarding renal toxicity.
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