Frequency and associated factors of amphotericin B nephrotoxicity in hospitalized patients in hematology-oncologywards in the southwest of Iran

Abstract

Background: Nephrotoxicity is the most clinically significant adverse reaction of amphotericin B. Different aspects of amphotericin B (AmB) nephrotoxicity have not been studied well in our population. Objectives: The purpose of this study was to assess the frequency, time onset, and possible associated factors of AmBnephrotoxicity in hospitalized patients in hematology-oncology wards in the southwest of Iran. Patients and Methods: A cross-sectional, observational study was performed over a period of 9 months at 2 hematology-oncology and 1 hematopoietic stem cell transplantation wards at Namazi Hospital. Patients aged 15 years or older with nodocumented history of acute kidney injury or chronic kidney disease who were scheduled to receive formulations of AmB intravenously for at least 1 week were included. The required demographic and clinical data of the patients were recorded. Urine urea, creatinine, sodium, potassium, and magnesium levels were measured at days 0, 3, 5, 7, 10, and 14 of the AmB treatment. AmB nephrotoxicity based on serum creatinine increase, renal potassium wasting, hypokalemia, and hypomagnesemia were determined. Results: Amongthe40patients recruited for the study, 11 (27.5%) patients developedAmBnephrotoxicity with amean±standard deviation onset of 6.73±2.36 days. In 5 patients, AmB nephrotoxicity resolved spontaneously without any intervention. According to the multivariate logistic regression model, none of the studied demographic, clinical, and paraclinical variables were significantly associated with AmB nephrotoxicity. The duration of hospitalization (P = 0.541) and the mortality rate (P = 0.723) were comparable between the patients with and without AmB nephrotoxicity. Hypokalemia and renal potassium wasting were identified in 45% and 27.5% of the patients during AmB treatment, respectively. Conclusions: Nearly one-third (27.5%) of our cohort developed nephrotoxicity within the firstweekof AmBtreatment. Hypokalemia and renal potassium wasting were more notable, affecting about one-third and one-half of the AmB recipients, respectively.