title: Incidence, Predictors, and Impact on Hospital Mortality of Amphotericin B Nephrotoxicity Defined Using Newer Acute Kidney Injury Diagnostic Criteria.
abstract: Studies on amphotericin B (AmB) nephrotoxicity use diverse definitions of acute kidney injury (AKI). Here, we used the new Kidney Disease Improving Global Outcome (KDIGO) system to describe the incidence, predictors, and impact of AmB-induced AKI on hospital mortality in 162 patients treated with AmB (120 with deoxycholate preparation and 42 with liposomal preparation). KDIGO stage 1 requires an absolute increase of ≥0.3 mg/dl or ≥1.5× over baseline serum creatinine (SCr), while stage 2 requires ≥2×, and stage 3 requires ≥3×. A binary KDIGO definition (KDIGObin) corresponds to stage ≥1. For comparison, we included two definitions of AKI traditionally utilized in nephrotoxicity studies: ≥0.5 mg/dl (NT0.5) and ≥2× (NT2×) increase in baseline SCr. The overall incidence of AmB-induced AKI by KDIGObin was 58.6% (stage 1, 30.9%; stage 2, 18.5%; stage 3, 9.3%). Predictors of AKI by KDIGObin were older age and use of furosemide and angiotensin-converting enzyme inhibitor (ACE-I). Traditional criteria detected lower incidences of AKI, at 45.1% (NT0.5) and 27.8% (NT2×). Predictors of AKI by traditional criteria were older age and use of vancomycin (NT0.5) and use of vancomycin and vasopressors (NT2×). KDIGObin detected AKI 2 days earlier than the most sensitive traditional criterion. However, only traditional criteria were associated with intensive care unit (ICU) admission, mechanical ventilation, and mortality. In conclusion, the increase in sensitivity of KDIGObin is accompanied by a loss of specificity and ability to predict outcomes. Prospective studies are required to weigh the potential gain from early AKI detection against the potential loss from undue changes in management in patients with subtle elevations in SCr.
authors.affiliation: Department of Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil paulonrocha@ufba.br.
authors.forename: Paulo Novis
authors.initials: PN
authors.lastname: Rocha
authors.affiliation: Department of Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Carla Dinamérica
authors.initials: CD
authors.lastname: Kobayashi
authors.affiliation: Department of Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Luna
authors.initials: L
authors.lastname: de Carvalho Almeida
authors.affiliation: Department of Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Camilla
authors.initials: C
authors.lastname: de Oliveira Dos Reis
authors.affiliation: Department of Medicine and Diagnostic Support, Medical School of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Barbara Mendes
authors.initials: BM
authors.lastname: Santos
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Marshall Jay
authors.initials: MJ
authors.lastname: Glesby
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology*; D000328:Adult; D000666:Amphotericin B / Q000009:adverse effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014640:Vancomycin / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D014640:Vancomycin; D000666:Amphotericin B; D003404:Creatinine