Study of renal safety in amphotericin B lipid complex-treated patients

To investigate the renal safety of amphotericin B lipid complex ( ABLC), records from 3514 ABLC- treated patients with fungal infections were reviewed. The median change in predicted creatinine clearance ( C (Cr)) from baseline to the end of therapy was - 3 mL/ min ( range, - 119 to 118 mL/ min); doubling of serum creatinine ( S- Cr) level occurred in 13% of patients, and new dialysis was needed for 3% of patients. Patients with underlying renal disease who had received prior antifungal therapy demonstrated a median C-Cr of 0.5 mL/ min ( range, - 107 to 52 mL/ min). Despite increased risk for renal impairment in allogeneic hematopoietic stem- cell transplant recipients, only 17% of patients demonstrated end- of- therapy doubling of S- Cr levels, and the median change in C-Cr was - 10 mL/ min ( range, -107 to 108 mL/ min). In ABLC- treated patients, concomitant treatment with potentially nephrotoxic agents and a baseline S- Cr level of <2 mg/ dL were factors predisposing for the development of nephrotoxicity. These data provide evidence that ABLC may be used safely to treat patients who are at increased risk for renal impairment.