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Sodium chloride treatment of amphotericin B nephrotoxicity. Standard of care?
1Department of Medicine, University of Colorado Health Sciences Center, Denver, USA.
Abstract:
Amphotericin B is an effective therapeutic agent for most systemic or invasive mycoses, but its usefulness is limited by the frequent occurrence of nephrotoxicity. Given the high and increasing frequency of serious fungal infections, especially in immunocompromised patients, the importance of the morbidity caused by this toxicity is substantial. Salt loading may prevent and even reverse amphotericin B-induced azotemia by an unknown mechanism. A prospective, randomized, placebo-controlled trial in a relevant patient group would strengthen the support for this simple, safe therapy, but will not likely be carried out because of practical and ethical considerations. Thus, a few prospective and limited controlled human studies may be the only supportive evidence for using this therapy. Supplementing dietary sodium chloride intake with 150 mEq of sodium chloride daily intravenously or orally beginning when or before amphotericin B therapy is initiated will likely prevent much of the observed nephrotoxicity and should be carried out routinely.
Insights
Salt loading can prevent or reverse kidney damage caused by Amphotericin B, an antifungal drug. This simple therapy should be routinely considered to mitigate Amphotericin B nephrotoxicity in patients with fungal infections.
Area of Science:
- Medical Mycology
- Nephrology
- Pharmacology
Background:
- Amphotericin B is a vital antifungal medication for systemic mycoses.
- Nephrotoxicity is a significant limitation of Amphotericin B therapy.
- Rising incidence of invasive fungal infections, particularly in immunocompromised individuals, heightens concerns regarding drug-induced toxicity.
Purpose of the Study:
- To evaluate the efficacy of salt loading in preventing or reversing Amphotericin B-induced nephrotoxicity.
- To provide evidence supporting the routine use of sodium chloride supplementation during Amphotericin B treatment.
Main Methods:
- Review of existing prospective and limited controlled human studies on salt loading and Amphotericin B.
- Consideration of a prospective, randomized, placebo-controlled trial, acknowledging practical and ethical limitations.
Main Results:
- Salt loading demonstrates potential to prevent and reverse Amphotericin B-induced azotemia.
- The precise mechanism underlying salt loading's protective effect remains to be fully elucidated.
Conclusions:
- Supplementation with 150 mEq of sodium chloride daily (intravenously or orally) is likely to prevent significant nephrotoxicity associated with Amphotericin B.
- Routine implementation of this salt loading strategy is recommended for patients undergoing Amphotericin B therapy.