The evaluation of frequency of nephrotoxicity caused by liposomal amphotericin B.

Abstract

Liposomal amphotericin B (L-AmB) was developed to reduce nephrotoxicity and maximize the therapeutic utility of amphotericin B in the treatment of invasive fungal infections. However, there is little investigation into the safety of L-AmB in patients with several renal functions. Therefore, we retrospectively evaluated the clinical safety of L-AmB among patients with several renal functions. We divided patients treated with L-AmB from April 2014 to September 2016 into 4 groups (estimated glomerular filtration rate (eGFR)≥60, 60>eGFR≥30, eGFR<30 and hemodialysis). The main endpoint was the incidence of nephrotoxicity and the difference in the serum creatinine values at the end of L-AmB treatment as compared with baseline. The incidence of nephrotoxicity was not significantly different among four groups (eGFR≥60; 27.0%, 60>eGFR≥30; 30.8%, eGFR<30; 50.0%, hemodialysis; 40.0%, p=0.56).Only one group of patients with eGFR≥60 admitted the significant increase of serum creatinine value after L-AmB treatment started (p<0.01). Patients admitted 0.5mg/dL or more of increase in serum creatinine values until 9 days from the L-AmB therapy started (eGFR≥60; 5.0 days [3.0-8.0 days], 60>eGFR≥30; 5.0 days [4.0-9.0 days], eGFR<30; 4.5 days [3.0-5.0 days], hemodialysis; 5.5 days [4.0-7.0 days], p=0.46). Take previous clinical study results together, our data suggested that L-AmB is safer agent than amphotericin B for the treatment of fungal infections in patients with eGFR<60 and hemodialysis patients at the start of treatment. Also, especially, we should use L-AmB more carefully until 9 days from the treatment started.