Nephrotoxicity of cyclosporine A and amphotericin B-deoxycholate as continuous infusion in allogenic stem cell transplantation.
BACKGROUND
Nephrotoxicity is an important side effect of amphothericin B deoxycholate (ampho B) and cyclosporine A (CsA). The combined administration of these drugs is frequent in patients with haematological diseases undergoing allogeneic stem cell transplantation.


OBJECTIVE
To assess the additional renal toxicity of ampho B given as a continuous infusion in addition to CsA.


METHODS
In a retrospective study renal function was investigated in patients receiving CsA alone or in combination with ampho B (24-hour infusion) after allogeneic stem cell transplantation between January 1998 and April 2001.


RESULTS
Of a total of 84 patients, 22 were treated with ampho B. There was a statistically significant decline in renal function in comparison to the 62 patients receiving CsA alone. However, renal insufficiency in all patients remained in a clinically acceptable range and was reversible. The residual renal dysfunction at the end of the hospitalisation was mainly due to continuing therapy with CsA.


CONCLUSIONS
Amphotericin B deoxycholate in addition to CsA leads to a statistically significant but clinically tolerable worsening of renal function. Using a 24-hour infusion and strict salt repletion, amphotericin B can be administered safely as deoxycholate in bone marrow transplant patients in conjunction with CsA for proven or suspected fungal infections.
D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects*; D016572:Cyclosporine / Q000009:adverse effects*; D003840:Deoxycholic Acid / Q000009:adverse effects*; D004338:Drug Combinations; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D033581:Stem Cell Transplantation
D004338:Drug Combinations; D003840:Deoxycholic Acid; D000666:Amphotericin B; D016572:Cyclosporine; C059765:amphotericin B, deoxycholate drug combination