Pharmacokinetics of liposomal amphotericin B during hemodialysis using polysulfone/high-flux membrane

Kajiwara, Kengo; Tomita, Masaru; Okamura, Kenjirô; Nakagawa, Terumasa; Sakanashi, Aya; Miura, Rei; Fujimoto, Kazuya; Kajiwara, Nao; Iwata, Yasunobu; Nobuoka, Mamiko; Matsunaga, Aiko; Yamamoto, Sayuri; Oobayashi, Hiroko; Yoshida, Kouichiro; Mukoyama, Masashi

doi:10.4009/jsdt.48.163

Cited by 2 publications

(4 citation statements)

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“…Based on the claims data for patients administered L-AMB, we compared the clinical usage of L-AMB in patients undergoing maintenance HD or CRRT to those who did not receive RRT. Consistent with previous reports [16][17][18][19][20], daily and cumulative dose, treatment duration, and dosing interval for L-AMB were not significantly different between patients receiving maintenance HD or CRRT and those that did not receive RRT. Except for three maintenance HD and one CRRT cases, none of the maintenance HD and CRRT cases required adjustment of the L-AMB dose of ≥ 0.5 mg/kg/day.…”

Section: Discussionsupporting

confidence: 91%

“…Although the dose of renal excretory antibiotics such as carbapenem and azole antifungal agents must be adjusted before they are administered to patients receiving RRT [21,22], several studies from single facilities have reported that the same dose of L-AMB could be administered to patients who either received or did not receive RRT. This is because RRT such as maintenance HD and CRRT does not affect the efficacy and pharmacokinetics of L-AMB [16][17][18][19][20]. However, large-scale clinical evidence from multiple facilities on the use of L-AMB in patients receiving RRT is needed to ensure that patients are appropriately administered this agent.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies from single facilities have reported that in critically ill patients receiving RRT, adjustment of the L-AMB dose is not necessary for those undergoing maintenance hemodialysis (HD) or continuous renal replacement therapy (CRRT). This is because RRT may not affect the efficacy and pharmacokinetics of L-AMB [16][17][18][19][20]. Studies conducted in Japan and other regions of the world have revealed that L-AMB is equally effective in patients receiving RRT, including maintenance HD or CRRT, as it is in those who do not receive RRT therapy, despite the limited number of study participants [16,17].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, in patients undergoing CRRT treated with L-AMB, no significant differences were observed in the L-AMB pharmacokinetic parameters compared with other patients in the group [ 18 ]. Another case study revealed no decline in the serum concentration of amphotericin B during L-AMB treatment in patients receiving HD [ 19 , 20 ]. However, a large-scale study using multicenter data is needed to verify these findings.…”

Section: Introductionmentioning

confidence: 99%

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The clinical usage of liposomal amphotericin B in patients receiving renal replacement therapy in Japan: a nationwide observational study

et al. 2020

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Background Liposomal amphotericin B (L-AMB), a broad-spectrum antifungicidal drug, is often used to treat fungal infections. However, clinical evidence of its use in patients with renal dysfunction, especially those receiving renal replacement therapy (RRT), is limited. Therefore, we evaluated the usage and occurrence of adverse reactions during LAMB therapy in patients undergoing RRT. Methods Using claims data and laboratory data, we retrospectively evaluated patients who were administered LAMB. The presence of comorbidities, mortality rate, treatment with LAMB and other anti-infective agents, and the incidence of adverse reactions were compared between patients receiving RRT, including continuous renal replacement therapy (CRRT) and maintenance hemodialysis (HD), and those that did not receive RRT. Results In total, 900 cases met the eligibility criteria: 24, 19, and 842 cases in the maintenance HD, CRRT, and non-RRT groups, respectively. Of the patients administered LAMB , mortality at discharge was higher for those undergoing either CRRT (15/19; 79%) or maintenance HD (16/24; 67%) than for those not receiving RRT (353/842; 42%). After propensity score matching, the average daily and cumulative dose, treatment duration, and dosing interval for LAMB were not significantly different between patients receiving and not receiving RRT. LAMB was used as the first-line antifungal agent for patients undergoing CRRT in most cases (12/19; 63%). Although the number of subjects was limited, the incidence of adverse events did not markedly differ among the groups. Conclusion LAMB may be used for patients undergoing maintenance HD or CRRT without any dosing, duration, or interval adjustments.

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Section: Discussionsupporting

confidence: 91%