Characterizing and predicting amphotericin B-associated nephrotoxicity in bone marrow or peripheral blood stem cell transplant recipients.
OBJECTIVE
To characterize amphotericin B-associated nephrotoxicity and to determine the variables associated with it that can be used to identify, a priori, at-risk patients.


METHODS
Retrospective analysis.


METHODS
University hospital.


METHODS
A homogeneous population of 69 recipients of a bone marrow (BMT) or peripheral blood stem cell transplant (PBSCT) with multiple myeloma and who received at least two doses of amphotericin B deoxycholate from January 1, 1992-January 1, 1995.


METHODS
Data on demographics, prior and concomitant nephrotoxic drug therapy, daily laboratory values, and amphotericin B dosing were collected serially from medical and pharmacy records.


RESULTS
Forward stepwise logistic regression analysis was performed on the data from the first day of therapy to characterize and determine variables related to amphotericin B-associated nephrotoxicity. Nephrotoxicity occurred in 30 patients (43%) and developed rapidly Patients who developed nephrotoxicity were similar to those who did not in many aspects associated with their treatment. However, baseline estimated creatinine clearance, cyclosporine therapy, nephrotoxic drug therapy within 30 days of starting amphotericin B, and the number of concomitant nephrotoxic drugs were significant predictors of amphotericin B-associated nephrotoxicity.


CONCLUSIONS
Recipients of a BMT or PBSCT who have multiple myeloma and are receiving cyclosporine or multiple nephrotoxic drugs at the start of amphotericin B therapy should be considered at high risk for developing amphotericin B-associated nephrotoxicity. Also, because amphotericin B-associated nephrotoxicity develops rapidly, clinicians should be aware of the rapid changes in serum creatinine and electrolyte levels that can occur.
Gubbins
Paul O
PO
College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock 72205-7122, USA. Gubbinspaulo@uams.edu
Penzak
Scott R
SR
Polston
Sabrena
S
McConnell
Scott A
SA
Anaissie
Elias
E
D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D003404:Creatinine / Q000097:blood; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced* / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy; D009181:Mycoses / Q000150:complications / Q000517:prevention & control; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies
D000935:Antifungal Agents; D000666:Amphotericin B; D003404:Creatinine