Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven aspergillosis

The records of 239 immunosuppressed patients receiving amphotericin B for suspected or proven aspergillosis were reviewed to determine rates of nephrotoxicity, dialysis, and fatality, The mean and median durations of treatment were 20.4 and 15.0 days, respectively. The creatinine level doubled in 53% of patients and exceeded 2.5 mg/dL in 29%; 14.5% underwent dialysis; and 60% died. A multivariate Cox proportional hazards analysis showed that patients whose creatinine level exceeded 2.5 mg/dL (hazard ratio [HR], 42.02; P < .001), allogeneic bone marrow transplantation (BMT) patients (HR, 6.34; P < .001), and autologous BMT patients (HR, 5.06; P = .024) were at greatest risk for requiring hemodialysis, Use of hemodialysis (HR, 3.089; P < .001), duration of amphotericin B use (HR, 1.03 per day; P = .015), and use of nephrotoxic agents (HR, 1.96; P = .017) were associated with greater risk of death, whereas patients undergoing solid organ transplantation were at lowest risk (HR, 0.46; P = .002). These data indicate that elevated creatinine levels during amphotericin a treatment are associated with a substantial risk for hemodialysis and a higher mortality rate, but the risks vary in different patient groups.