Correlates of acute renal failure in patients receiving parenteral amphotericin B

Bates, David W.; Ling, Su; Yu, Dong; Chertow, Glenn M.; Seger, Diane L.; Gomes, Daniel; Platt, Richard

doi:10.1046/j.1523-1755.2001.00948.x

Cited by 121 publications

(82 citation statements)

References 16 publications

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“…The cumulative dose of amphotericin could, perhaps, explain the low incidence of renal alterations. However, in a large retrospective study including more than 600 patients [18], the sub-group of patients that received less than 500 mg/period of AmphoB had an ARF incidence of 22%, defined by doubling of the serum creatinine, with a peak of at least 3.0 mg/dL. In another study with non-selected patients that compared AmphoB with liposomal amphotericin, the incidence of ARF, defined by an increase of 100% in the final creatinine levels, when compared to the initial levels, was 50% in the group that received AmphoB, with a cumulative dose of 6.18 mg/kg, a dosage very similar to the one received by the patients in our study [16].…”

Section: Discussionmentioning

confidence: 99%

Amphotericin B-related nephrotoxicity in low-risk patients

Berdichevski¹,

Luis²,

Crestana³

et al. 2006

Braz J Infect Dis

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Introduction. Amphotericin B (AmphoB) is the drug of choice for treatment of severe fungal illnesses; however, it is very nephrotoxic. Modified (less toxic) amphotericins are very expensive. In low-risk patients, saline loading would be enough to prevent significant loss of renal function. Material and Methods. Patients with normal renal function and within the first 24 hours of treatment with AmphoB were prospectively enrolled in the study. Patients in intensive care units or who were using vasoactive drugs were excluded. Saline loads were infused before and after the AmphoB treatment. Blood and urine analyses were made at the beginning and at the end of the treatment. Serum creatinine was repeated 30 days after the end of the AmphoB treatment. Results. The mean increase in serum creatinine in the 48 patients was 0.3 (0.18-0.41) mg/dL, due to a mean decrease of 25 (12.8-36.9) mL/min of creatinine clearance (CrCl). Acute renal failure, defined as an increase of more than 50% of the baseline creatinine, occurred in 15 patients (31%). Patients that were on antibiotics, in post-chemotherapy status or those submitted to bone marrow transplantation had the highest risk. Mean serum creatinine and the CrCl levels were no different from baseline values after 30 days. Conclusion. In low-risk patients, the use of AmphoB with prophylactic sodium chloride loading was associated with a small and reversible decrease in renal function. Due to its high cost the use of more expensive therapies for this type of patient does not seem to be justified.

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Section: Discussionmentioning

confidence: 99%

Amphotericin B-related nephrotoxicity in low-risk patients

Berdichevski¹,

Luis²,

Crestana³

et al. 2006

Braz J Infect Dis

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“…Multiple risk factors for the development of AKI have been described in critically ill patients and include, but are not limited to, CKD, cardiovascular disease (CVD), elevated bilirubin, cancer, high-risk surgery, hypotension, increased body mass index, and hypertension (1,(17)(18)(19)(20). However, because many of the aforementioned risk factors are common in critically ill patients, developing a risk factor profile to identify patients at risk has proven challenging.…”

Section: Introductionmentioning

confidence: 99%

Utilization of Small Changes in Serum Creatinine with Clinical Risk Factors to Assess the Risk of AKI in Critically lll Adults

Cruz¹,

Ferrer-Nadal²,

Piccinni³

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Disease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient's clinical course. We set out to assess the performance of this combination approach.Design, setting, participants, & measurements A secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1-0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit.Results Of 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P,0.001). The sensitivity of this grouping for severe AKI was 92%, the specificity was 62%, the positive predictive value was 16%, and the negative predictive value was 99%. After adjustment for Sequential Organ Failure Assessment score, serum creatinine, and hazard tier for AKI, early creatinine elevation remained an independent predictor for severe AKI (adjusted relative risk, 12.86; 95% confidence interval, 3.52 to 46.97). Addition of early creatinine elevation to the best clinical model improved prediction of the primary outcome (area under the receiver operating characteristic curve increased from 0.75 to 0.83, P,0.001). ConclusionCritically ill patients at high AKI risk, based on the combination of clinical factors and early creatinine elevation, are significantly more likely to develop severe AKI. As initially hypothesized, the high-risk combination group methodology can be used to identify patients at low risk for severe AKI in whom AKI biomarker testing may be expected to have low yield. The high risk combination group methodology could potentially allow clinicians to optimize biomarker use.

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“…Catheters were not removed in patients who needed to central line to receive treatment intravenously, due to trouble with intravenous route. Nephrotoxicity was defined as an increase in serum creatinine value greater than two times the baseline value or with a peak [2.0 mg/dL [10]. Hypokalemia was defined as a serum potassium level \3.5 mmol/L (\3.5 mEq/L).…”

Section: Methodsmentioning

confidence: 99%

Novel Antifungal Drugs Against Fungal Pathogens: Do They Provide Promising Results for Treatment?

Gedık

Şimşek

Yıldırmak

et al. 2014

Indian J Hematol Blood Transfus

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The febrile neutropenia episodes of hematological patients and their outcomes were evaluated with respect to fungal pathogens and antifungal therapy in this retrospective study. All patients, who were older than 14 years of age and developed at least one neutropenic episode after chemotherapy due to hematological cancer from November 2010 to November 2012, were included into the study. We retrospectively collected demographic, treatment, and survival data of 126 patients with neutropenia and their 282 febrile episodes. The mean Multinational Association for Supportive Care in Cancer score was 17.18 ± 8.27. Systemic antifungal drugs were initiated in 22 patients with 30 culture-proven invasive fungal infections (IFIs), 25 attacks of 19 patients with probable invasive pulmonary aspergillosis (IPA), 42 attacks of 38 patients with possible IPA, and 31 attacks of 30 patients with suspected IFI. Voriconazole (VOR), caspofungin and liposomal amphotericin B were used to treat 72 episodes of 65 patients, 45 episodes of 37 patients and 34 episodes of 32 patients as a first-line therapy, respectively. Unfavorable conditions of our hematology ward are thought to increase the number of cases with invasive pulmonary aspergillosis and VOR use. It should be taken into consideration that increased systemic and per oral VOR usage predisposes patients to colonization and infection with azole-resistant fungal strains. Catheters should be removed in cases where patients' conditions are convenient to remove it. Acute myeloblastic leukemia cases that are more likely to develop invasive fungal infections should be monitored closely for early diagnosis and timely initiation of antifungal drugs which directly correlates with survival rates.

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Correlates of acute renal failure in patients receiving parenteral amphotericin B

Cited by 121 publications

References 16 publications

Amphotericin B-related nephrotoxicity in low-risk patients

Amphotericin B-related nephrotoxicity in low-risk patients

Utilization of Small Changes in Serum Creatinine with Clinical Risk Factors to Assess the Risk of AKI in Critically lll Adults

Novel Antifungal Drugs Against Fungal Pathogens: Do They Provide Promising Results for Treatment?

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