Amphotericin B associated nephrotoxicity – A single center retrospective study

Abstract

Objectives: To analyze frequency of acute kidney injury (AKI) and electrolyte derangements associated with the use of amphotericin B deoxycholate (conventional amphotericin B) and comparison of these adverse effects between children and adults.

Materials & Methods: This is a retrospective study. Medical records of patients who received amphotericin B deoxycholate during 12 months from 1st May 2016 to 30th April 2017 were reviewed to determine patient’s baseline characteristics, and to identify use of amphotericin B and calculate incidence of associated nephrotoxicity.

Results: A total of 228 patients received amphotericin B deoxycholate in the study duration. Most of our patients were males (65.8%). 51.75% were adults (=18 years of age). Most patients had cancer and acute lymphoblastic leukemia was the most  common primary diagnosis (34.2%). 6.6% patients had co morbid conditions at baseline. Most of our patients developed amphotericin B related adverse effects. Out of 228 patients who received amphotericin B deoxycholate, 80% developed hypokalemia. Hypokalemia was observed more commonly amongst the pediatric population (86.4%) as compared to adults (74.6%).  Similarly, 61% children and 45% adults developed hypomagnesemia. Moreover, 59.2% patients developed acute
kidney injury (AKI) with amphotericin B therapy, 9 of which required renal replacement therapy. Development of acute kidney injury was seen more frequently among adults (63.6%), as compared to children (54.5%). 30 days survival among children was 70% as compared to 60% for adults.

Conclusions: The results of the present study allow documentation of adverse effects associated with the use of conventional amphotericin B. This data shows that conventional amphotericin B is commonly associated with electrolyte abnormalities and acute kidney injury. This highlights the need for availability of liposomal or lipid-based formulations of amphotericin B in our
country.

Key Words: Amphotericin B, AKI, Electrolyte Imbalance