title: Nephrotoxicity and other adverse events among inpatients receiving liposomal amphotericin B or amphotericin B lipid complex.
abstract: Nephrotoxicity evaluations between liposomal amphotericin B (L-AMB) and amphotericin B lipid complex (ABLC) have provided mixed results. This retrospective study used an electronic medical record database of hospitalized patients with invasive fungal infections treated with either L-AMB or ABLC. Patients had renal insufficiency, clinical condition suggesting intolerance to amphotericin B deoxycholate (CAB), or recent CAB exposure. Baseline SCr, exposure to other nephrotoxic agents, and total amphotericin B exposure were similar between the groups. In 105 patients administered L-AMB, 10.6% had nephrotoxicity versus 22.6% of 222 patients administered ABLC (P = 0.020). A logistic regression model found ABLC patients had 3.48 higher odds (95% CI 1.05-11.52) than L-AMB of developing nephrotoxicity. Infusion reactions were more prevalent with ABLC (23.9% versus 9.5%, P = 0.002) as was hypomagnesemia (44.3% versus 28.1%, P = 0.033). This study demonstrated that L-AMB is associated with less nephrotoxicity, infusion reactions and hypomagnesemia than ABLC in patients at increased risk of nephrotoxicity.
authors.affiliation: Cerner Research, Culver City, CA, USA.
authors.forename: Rolin L
authors.initials: RL
authors.lastname: Wade
authors.forename: Paresh
authors.initials: P
authors.lastname: Chaudhari
authors.forename: Jaime L
authors.initials: JL
authors.lastname: Natoli
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Taylor
authors.forename: Brian H
authors.initials: BH
authors.lastname: Nathanson
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D003840:Deoxycholic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009181:Mycoses / Q000188:drug therapy*; D051437:Renal Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents; D004338:Drug Combinations; C068538:liposomal amphotericin B; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination