scholarly journals Renal Recovery following Liposomal Amphotericin B-Induced Nephrotoxicity

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Heather A. Personett ◽  
Bryce M. Kayhart ◽  
Erin F. Barreto ◽  
Pritish Tosh ◽  
Ross Dierkhising ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Renal Recovery ◽  
Cumulative Exposure ◽  
Liposomal Amphotericin B

Background. Acute kidney injury (AKI) is a common complication of treatment with liposomal amphotericin B (LAmB). The trajectory of renal recovery after LAmB-associated AKI has not been well described, nor has effect of LAmB dose on recovery of renal function been explored. Objective. Characterize the pattern of renal recovery after incident AKI during LAmB and determine potential influencing factors. Methods. This retrospective cohort study analyzed patients who developed a ≥50% increase in serum creatinine while on LAmB. Patients were followed up until complete renal recovery or death or for 30 days, whichever occurred first. The primary outcome was complete renal recovery, defined as serum creatinine convalescence to within 10% of the patient’s pretreatment baseline. Multivariable modeling was used to identify independent predictors of renal recovery. Results. Ninety-eight patients experienced nephrotoxicity during LAmB, 94% of which received doses <7 mg/kg/day. Fifty-one patients at least partially recovered renal function and, of these, 32 exhibited complete recovery after a mean 9.8 ± 7.8 days. No statistical relationship was found between LAmB dose at the time of AKI or cumulative exposure to LAmB and the likelihood of renal recovery. Concomitant nephrotoxins, age, and pretreatment renal function did not modify this effect in multivariable analysis. Conclusion and Relevance. Our data suggests that LAmB dose did not impact the likelihood of renal recovery. Additional investigation is needed to confirm these findings when aggressive dosing strategies are employe. Additional research is also warranted to further characterize the course of recovery after LAmB-associated nephrotoxicity and comprehensive spectrum of renal outcomes.

Benefit of Early Switch to Liposomal Amphotericin B in Patients with Amphotericin B Deoxycholate-Induced Nephrotoxicity Versus Late Switch.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5381-5381
Author(s):  
Françoise Isnard ◽  
Jean P. Laporte ◽  
Patrice Chevallier ◽  
Arnaud Pigneux ◽  
Patrick Tilleul ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Randomised Trial ◽  
Multicenter Trial ◽  
Liposomal Amphotericin B ◽  
Drug Induced ◽  
A Value ◽  
Amphotericin B Deoxycholate

Abstract Amphotericin B deoxycholate (AmBd) nephrotoxicity increases morbidity and mortality however there are no clear guidelines when to switch to liposomal amphotericin B (LAB). We evaluated the benefit of Early Switch (ES) to LAB in patients with AmBd compared to Late Switch (LS). In this prospective randomized multicenter trial, standard AmBd 1mg/kg/d is initiated in neutropenic patients with haematological malignancies as empirical antifungal therapy (V0). If serum creatinine (SCr) increased of 30% from baseline V0, they were randomized (V1) to LAB 3mg/kg/d (ES) or to pursue AmBd (no switch). In a second step, AmBd treated patients were switched to LAB (LS) if their serum creatinine doubled from V0 or reached a value ≥ 170 μmol/l up to the end of treatment (V2). The analysis included 29 patients [ES=14; no switch=15 with late switch for 9 of them]. Demographics and mean duration of AmBd treatment prior randomization were similar in both groups. Early switch allowed a statistically significant (p=0.04) decrease in serum creatinine (−3.1%) from V1 to V2 as compared with a mean increase of +16.2% in the LS + no switch groups and also demonstrated a significant (p=0.04) increase (+5.1%) in creatinine clearance (ml/min) compared to a decrease (−10.3%) in the LS + no switch groups. This randomised trial demonstrated that an early switch to LAB improves and preserves renal function compared with late switch. Significant reduction of drug-induced nephrotoxicity may impact positively clinical outcomes and provide patients with greater options for chemotherapy treatments. Evolution of renal function Criteria (mean) ES LS + no switch p SCr at V0 (μmol/l) 67.2 67.3 NS SCr at V1 (μmol/l) 109.0 108.2 NS SCr at V2 (μmol/l) 104.5 123.1 0.08 Evolution of SCr V1 - V2 (%) − 3.1 + 16.2 0.04 Evolution of ClCr V1 - V2 (%) + 5.1 − 10.3 0.04

scholarly journals Efficacy of fluid infusions on the recovery from acute kidney injury in patients administered liposomal amphotericin B: A nationwide observational study

2021 ◽  
Author(s):  
Masato Tashiro ◽  
Yoko Obata ◽  
Takahiro Takazono ◽  
Yuki Ota ◽  
Tomotaro Wakamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Recovery Rate ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Fold Increase ◽  
Fluid Volume ◽  
Renal Recovery ◽  
Liposomal Amphotericin B ◽  
Fluid Infusion

Abstract Background: Acute kidney injury (AKI) often develops during the administration of liposomal amphotericin B (L-AMB), a broad-spectrum antifungal drug. However, clinical recovery approaches for AKI patients administered L-AMB have not been well established.Methods: A retrospective analysis was conducted using data obtained from hospitals throughout Japan. AKI was defined as a ≥1.5-fold increase within 7 days or ≥0.3 mg/dL increase within 2 days in serum creatinine. Renal recovery was defined as a return to creatinine levels below those recorded before the onset of AKI.Results: Herein, 189 patients had developed AKI following L-AMB administration. Of them, 153 were subsequently assessed to determine the trend in creatinine level after AKI and 90 patients were assessed for renal recovery. Patients administered ≥10 mL/kg daily fluid for 7 consecutive days from the onset of AKI had a 63% recovery rate relative to patients that did not receive infusion (35% recovery rate (P = 0.053)). Although extending the fluid infusion period beyond 7 days did not result in consistent improvement in renal recovery rates, daily fluid volume was found to be positively correlated with renal recovery (P = 0.043). On average, patients administered daily fluid infusions of ≥10 mL/kg had greater reductions in minimum creatinine levels for the first 7 days after AKI compared to patients that did not receive daily fluid infusions. After 7 days of fluid infusion, the mean minimum creatinine levels decreased by 0.21 mg/dL relative to 0.16 mg/dL for patients that did not receive daily fluid infusions.Conclusions: Seven consecutive days of daily fluid infusion from the onset of AKI may promote renal recovery from AKI in patients administered L-AMB, with daily fluid volume positively correlating with the incidence of renal recovery.

scholarly journals Factor Analysis in Decreased Expression of Renal Function by Liposomal-Amphotericin B

2014 ◽  
Vol 40 (2) ◽  
pp. 94-99 ◽  
Author(s):  
Yusuke Saito ◽  
Eiji Horita ◽  
Tomoki Uesaka ◽  
Yukiko Hayashi ◽  
Yoshifumi Kaizaki ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Renal Function ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B

Impact of the Administration of Liposomal Amphotericin B in Patients with Renal Function Impairment at Initiation of Treatment

2010 ◽  
Vol 22 (4) ◽  
pp. 285-287 ◽  
Author(s):  
F. Álvarez-Lerma ◽  
F. Mariscal ◽  
E. Quin-Tana ◽  
G. Rialp ◽  
J. Díaz-Regañón ◽  
...  
Keyword(s):  
Renal Function ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Renal Function Impairment ◽  
Function Impairment

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

scholarly journals Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takahiro Takazono ◽  
Masato Tashiro ◽  
Yuki Ota ◽  
Yoko Obata ◽  
Tomotaro Wakamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Angiotensin Receptor Blockers ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Fold Increase ◽  
Liposomal Amphotericin B ◽  
Converting Enzyme Inhibitors

Abstract Liposomal amphotericin B (L-AMB) is a broad-spectrum antifungal drug that is used to treat fungal infections. However, clinical evidence of its use in patients with renal failure is limited. Here, we aimed to identify factors associated with acute kidney injury (AKI) in patients administered L-AMB. We retrospectively utilized a combination of Diagnosis Procedure Combination data and laboratory data obtained from hospitals throughout Japan between April 2008 and January 2018. In total, 507 patients administered L-AMB were identified. After L-AMB treatment initiation, AKI, which was defined as a ≥ 1.5-fold increase within 7 days or ≥ 0.3 mg/dL increase within 2 days in serum creatinine according to the KDIGO criteria, was recognized in 37% of the total patients (189/507). The stages of AKI were stage 1 in 20%, stage 2 in 11%, and stage 3 in 7%. Five factors were associated with AKI of all stages: prior treatment with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or carbapenem; concomitant administration of catecholamines or immunosuppressants; and ≥ 3.52 mg/kg/day of L-AMB dosing. Serum potassium < 3.5 mEq/L before L-AMB therapy was associated with severe AKI of stage 2 and 3. Altogether, these factors should be carefully considered to reduce the occurrence of AKI in patients administered L-AMB.

scholarly journals Case-Control Study and Case Series of Pseudohyperphosphatemia during Exposure to Liposomal Amphotericin B

2015 ◽  
Vol 59 (11) ◽  
pp. 6816-6823 ◽  
Author(s):  
Nicole M. Bohm ◽  
Katherine C. Hoover ◽  
Amy E. Wahlquist ◽  
Yusheng Zhu ◽  
Juan Carlos Q. Velez
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Case Control Study ◽  
Case Series ◽  
Kidney Injury ◽  
Case Control ◽  
Liposomal Amphotericin B ◽  
Control Study ◽  
Phosphorus Levels

ABSTRACTPseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases;P< 0.01; adjusted odds ratio, 5.2 [95% confidence interval {CI}, 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases;P< 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

Subclinical tumor lysis-like syndrome during treatment of visceral leishmaniasis with low-dose intermittent liposomal amphotericin B

Open Medicine ◽  
2012 ◽  
Vol 7 (3) ◽  
pp. 305-309
Author(s):  
Sarah Georgiadou ◽  
Dimitrios Kontoyiannis ◽  
Nikolaos Sipsas
Keyword(s):  
Renal Function ◽  
Visceral Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Low Dose ◽  
Parasite Load ◽  
Liposomal Amphotericin B ◽  
Tumor Lysis ◽  
Electrolyte Disturbances ◽  
High Parasite

AbstractWe retrospectively evaluated the rate of renal dysfunction during treatment with liposomal amphotericin B (L-AmB) (3–4 mg/kg, for 7–10 days) in nine consecutive patients with visceral leishmaniasis (VL). During the first week of treatment, 5 patients (56%) experienced transient deterioration of renal function, with a rise in serum creatinine to 1.27–2.44 times the baseline level, and a parallel elevation of uric acid levels without other metabolic or electrolyte disturbances. Serum renal function parameters were restored to normal levels after the completion of therapy, on day 21. These 5 patients had presented with prolonged fever and/or significant spleen enlargement, reflecting high parasite load. This observation suggests that treatment of VL with intermittent L-AmB causes a subclinical tumor lysis-like syndrome, especially in patients with high parasite load.

scholarly journals Coadministration of Liposomal Amphotericin B and Contrast Medium Does Not Increase Risk of Kidney Injury

2017 ◽  
Vol 61 (8) ◽  
Author(s):  
John C. O'Horo ◽  
Douglas R. Osmon ◽  
Omar M. Abu Saleh ◽  
Jasmine R. Marcelin ◽  
Kamel A. Gharaibeh ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Liposomal Amphotericin B ◽  
Intravenous Contrast ◽  
Intravenous Contrast Medium ◽  
Increased Risk ◽  
Propensity Score Adjustment

ABSTRACT Intravenous radiographic contrast medium and amphotericin B are commonly required in the care of patients with fungal infections. Both interventions have proposed nephrotoxicity through similar mechanisms. We systematically examined patients who received coadministration of liposomal amphotericin B (AmBisome; GE Healthcare) and intravenous contrast medium within a 24-h period and compared the results for those patients with the results for patients who underwent non-contrast medium studies. We found 114 cases and 85 controls during our study period. Overall, no increased risk of renal injury was seen with coadministration of these 2 agents. Adjustment for age, baseline kidney function, and other clinical factors through propensity score adjustment did not change this result. Our observations suggest that, when clinically indicated, coadministration of contrast medium and liposomal amphotericin B does not present excess risk compared with that from the administration of liposomal amphotericin B alone.

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