Wood James E, Mahnensmith Mary P, Mahnensmith Rex L, Perazella Mark A
Department of Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.
Am J Med Sci. 2004 Jan;327(1):5-8. doi: 10.1097/00000441-200401000-00002.
Amphotericin B is used commonly to treat fungal infections. Unfortunately, little information exists regarding the use of intravenous amphotericin B in patients with end-stage renal disease (ESRD).
We retrospectively reviewed the clinical course of patients receiving amphotericin B during hemodialysis (HD). Twenty-five episodes of systemic fungal infection occurring in 24 patients with ESRD treated with parenteral amphotericin B administered during HD were noted. Patients received a maintenance dose of 0.5 to 1.0 mg/kg amphotericin B intravenously thrice weekly during HD sessions. Twenty-three patients received either 500 or 1000 mg of amphotericin B, whereas 1 patient with AIDS received a total of 6,500 mg.
Intradialytic hypotension developed in 27.7% of HD sessions during treatment with amphotericin B compared with 28.8% of 20 HD sessions evaluated before initiation of amphotericin B therapy. Four patients exhibited a temperature rise greater than 38.8 degrees C during drug infusion (1 episode per patient). Increases in heart rate and ventricular ectopy were rare. Serum potassium concentrations as well as Kt/V and urea reduction ratio did not change significantly. All patients (except the patient with AIDS) resolved their respective fungal infections.
Intradialytic administration of amphotericin B was generally well tolerated. Our observations suggest that amphotericin B is effective and safe for outpatient intradialytic therapy when administered according to protocol.
两性霉素B常用于治疗真菌感染。遗憾的是，关于终末期肾病（ESRD）患者使用静脉注射两性霉素B的信息很少。
我们回顾性分析了接受血液透析（HD）期间使用两性霉素B的患者的临床病程。记录了24例接受HD期间静脉注射两性霉素B治疗的ESRD患者发生的25次全身性真菌感染。患者在HD期间每周三次静脉注射维持剂量为0.5至1.0mg/kg的两性霉素B。23例患者接受了500或1000mg的两性霉素B，而1例艾滋病患者共接受了6500mg。
两性霉素B治疗期间，27.7%的HD疗程出现透析中低血压，而在两性霉素B治疗开始前评估的20个HD疗程中，这一比例为28.8%。4例患者在药物输注期间体温升高超过38.8℃（每位患者1次）。心率增加和室性早搏很少见。血清钾浓度以及Kt/V和尿素清除率没有明显变化。所有患者（艾滋病患者除外）均治愈了各自的真菌感染。
透析中给予两性霉素B一般耐受性良好。我们的观察结果表明，按照方案给药时，两性霉素B对于门诊透析中治疗是有效且安全的。
