Personett Heather A, Kayhart Bryce M, Barreto Erin F, Tosh Pritish, Dierkhising Ross, Mara Kristin, Leung Nelson
Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
Department of Pharmacy, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
Int J Nephrol. 2019 Jan 28;2019:8629891. doi: 10.1155/2019/8629891. eCollection 2019.
Acute kidney injury (AKI) is a common complication of treatment with liposomal amphotericin B (LAmB). The trajectory of renal recovery after LAmB-associated AKI has not been well described, nor has effect of LAmB dose on recovery of renal function been explored.
Characterize the pattern of renal recovery after incident AKI during LAmB and determine potential influencing factors.
This retrospective cohort study analyzed patients who developed a ≥50% increase in serum creatinine while on LAmB. Patients were followed up until complete renal recovery or death or for 30 days, whichever occurred first. The primary outcome was complete renal recovery, defined as serum creatinine convalescence to within 10% of the patient's pretreatment baseline. Multivariable modeling was used to identify independent predictors of renal recovery.
Ninety-eight patients experienced nephrotoxicity during LAmB, 94% of which received doses <7 mg/kg/day. Fifty-one patients at least partially recovered renal function and, of these, 32 exhibited complete recovery after a mean 9.8 ± 7.8 days. No statistical relationship was found between LAmB dose at the time of AKI or cumulative exposure to LAmB and the likelihood of renal recovery. Concomitant nephrotoxins, age, and pretreatment renal function did not modify this effect in multivariable analysis.
Our data suggests that LAmB dose did not impact the likelihood of renal recovery. Additional investigation is needed to confirm these findings when aggressive dosing strategies are employe. Additional research is also warranted to further characterize the course of recovery after LAmB-associated nephrotoxicity and comprehensive spectrum of renal outcomes.
急性肾损伤（AKI）是脂质体两性霉素B（LAmB）治疗常见的并发症。LAmB相关AKI后肾脏恢复的轨迹尚未得到充分描述，LAmB剂量对肾功能恢复的影响也未被探讨。
描述LAmB治疗期间发生AKI后肾脏恢复的模式，并确定潜在影响因素。
这项回顾性队列研究分析了在接受LAmB治疗期间血清肌酐升高≥50%的患者。对患者进行随访，直至肾脏完全恢复、死亡或30天，以先发生者为准。主要结局是肾脏完全恢复，定义为血清肌酐恢复至患者治疗前基线水平的10%以内。采用多变量建模来确定肾脏恢复的独立预测因素。
98例患者在接受LAmB治疗期间出现肾毒性，其中94%接受的剂量<7mg/kg/天。51例患者至少部分恢复了肾功能，其中32例在平均9.8±7.8天后完全恢复。在AKI发生时的LAmB剂量或LAmB的累积暴露量与肾脏恢复的可能性之间未发现统计学关系。在多变量分析中，同时使用的肾毒素、年龄和治疗前肾功能并未改变这种影响。
我们的数据表明，LAmB剂量不影响肾脏恢复的可能性。当采用积极的给药策略时，需要进一步研究以证实这些发现。还需要进一步研究以进一步描述LAmB相关肾毒性后的恢复过程及肾脏结局的全面情况。
