Renal effects of amphotericin B lipid complex

A study was conducted to compare the renal effects of amphotericin B lipid complex (ABLC), a lipid formulation of the widely used antifungal medication, with conventional amphotericin B (AmB) in the treatment of serious fungal infections, including invasive candidiasis, cryptococcal meningitis, and aspergillosis. The clinical experience of ABLC includes two types of open-label studies: randomized comparative (ABLC 5 mg/kg/d compared with AmB 0.6 to 1 mg/kg) and emergency use. In the comparative studies, changes in serum creatinine were evaluated three ways: doubling of the baseline value, an increase from less than or equal to 1.5 mg/dL at baseline to greater than or equal to 1.5 mg/dL, and an increase from less than or equal to 1.5 mg/dL at baseline to greater than or equal to 2.0 mg/dL. More patients in the AmB group reached these end points than in the ABLC group (P less than or equal to 0.007), and the time needed to reach each of these end points was significantly shorter for the AmB group (P less than or equal to 0.02). Increased serum creatinine was reported as an adverse event more frequently by patients receiving AmB than by patients receiving ABLC. In the emergency use study, a steady and statistically significant decrease in serum creatinine was observed among patients who started ABLC treatment with serum creatinine greater than 2.5 mg/dL due to prior AmB treatment. ABLC offers the physician a valuable, less nephrotoxic alternative to AmB for the treatment of patients with severe, invasive fungal infections, (C) 1998 by the National Kidney Foundation, Inc.