title: Lipid formulations of amphotericin B preserve and stabilize renal function in HSCT recipients.
abstract: The current study assessed renal function based on medical records in adult hematopoietic stem cell transplant (HSCT) recipients with proven or probable invasive fungal infection (IFI) transplanted between 1995 and 2000. We confirm that amphotericin B deoxycholate (AmB-d) is nephrotoxic in a large percentage of HSCT recipients. Due to nephrotoxicity, defined as serum creatinine (SCr) >2.5 mg/dl or a 100% increase in SCr from baseline, 88% of patients treated with AmB-d were switched to a lipid formulation of amphotericin B (LFAB). In total, 53% of patients initiated on AmB-d were switched within the first week of therapy. Significantly more patients (70.6%) treated with AmB-d experienced a 100% increase in SCr from baseline compared to patients treated with either AmBisome (44.4%) or Abelcet (41.2%). A Cox Proportional Hazards Model revealed that, compared to patients initiated on AmBisome or Abelcet, the risk of nephrotoxicity (RR=1.5 vs AmBisome; RR=1.7 vs Abelcet), dialysis (RR=2.4 vs AmBisome; RR=1.4 vs Abelcet), and death (RR=2.0 vs AmBisome; RR=1.1 vs Abelcet) were all increased for patients initiated on AmB-d. Study results suggest that renal function improves and mortality declines when an LFAB is given to HSCT patients as initial therapy rather than as second-line therapy, the current practice.
authors.affiliation: St Agnes Healthcare, Durham, NC, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Miller
authors.forename: E K
authors.initials: EK
authors.lastname: Waller
authors.forename: H G
authors.initials: HG
authors.lastname: Klingemann
authors.forename: M C
authors.initials: MC
authors.lastname: Dignani
authors.forename: E J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: P J
authors.initials: PJ
authors.lastname: Cagnoni
authors.forename: P
authors.initials: P
authors.lastname: McSweeney
authors.forename: P R
authors.initials: PR
authors.lastname: Fleck
authors.forename: S M
authors.initials: SM
authors.lastname: Fruchtman
authors.forename: J
authors.initials: J
authors.lastname: McGuirk
authors.forename: N J
authors.initials: NJ
authors.lastname: Chao
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000502:physiology*; D007674:Kidney Diseases / Q000139:chemically induced / Q000517:prevention & control; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B