1996 年至 2020 年全身性真菌感染接受两性霉素 B 治疗的犬的急性肾损伤发生率。

Incidence of acute kidney injury in dogs with systemic mycotic infections treated with amphotericin B (1996-2020).

机构信息

William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, USA.

Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA.

出版信息

J Vet Intern Med. 2023 May-Jun;37(3):1030-1037. doi: 10.1111/jvim.16728. Epub 2023 May 6.

DOI:10.1111/jvim.16728

PMID:37148178

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10229337/

Abstract

BACKGROUND

Amphotericin-B (AmB) is an essential medication for the treatment of life-threatening systemic mycoses but the incidence and risk factors for acute kidney injury (AKI) after its administration are not known in dogs.

OBJECTIVE

Determine the incidence of and risk factors for AKI in dogs receiving AmB.

ANIMALS

Fifty-one client owned dogs receiving AmB for the treatment of systemic mycoses.

METHODS

Retrospective study. Signalment, potential risk factors, AKI development (creatinine ≥0.3 mg/dL from baseline), drug formulation (deoxycholate [AmB-D] or lipid complex [ABLC]), dose, and treatment duration were recorded. The probability of an AKI diagnosis was evaluated using a log-rank test. The incidence of AKI and odds ratios were calculated for potential risk factors.

RESULTS

Incidence of AKI was 5/12 (42%) for dogs receiving AmB-D and 14/39 (36%) for dogs receiving ABLC. Of the 19 dogs that developed AKI, 16 (84%) continued treatment after a pause in the planned dosing protocol. Fifty percent of dogs received a cumulative dose of 6.9 mg/kg for AmB-D and 22.5 mg/kg for ABLC (P < .01) at time of AKI diagnosis. ICU hospitalization (odds ratio [OR] 0.21, 95% confidence interval [CI]: 0.58-0.87) and inpatient status (OR 0.25, 95% CI: 0.07-0.86) were associated with decreased odds of AKI.

CONCLUSIONS AND CLINICAL IMPORTANCE

Incidence of AKI with AmB is common but does not always preclude continued treatment. The incidence of AKI is similar between AmB-D and ABLC, but dogs receiving ABLC tolerated a higher cumulative total dose before AKI diagnosis.

摘要

背景

两性霉素 B（AmB）是治疗危及生命的全身真菌感染的重要药物，但在狗中，其使用后急性肾损伤（AKI）的发生率和危险因素尚不清楚。

目的

确定接受两性霉素 B 治疗的狗 AKI 的发生率和危险因素。

动物

51 只因全身真菌感染接受两性霉素 B 治疗的患犬。

方法

回顾性研究。记录了一般信息、潜在危险因素、AKI 发展（与基线相比肌酐≥0.3mg/dL）、药物制剂（去氧胆酸盐[AmB-D]或脂质复合物[ABLC]）、剂量和治疗持续时间。使用对数秩检验评估 AKI 诊断的可能性。计算 AKI 的发生率和潜在危险因素的比值比。

结果

接受 AmB-D 的犬 AKI 的发生率为 5/12（42%），接受 ABLC 的犬 AKI 的发生率为 14/39（36%）。在发生 AKI 的 19 只犬中，有 16 只（84%）在计划的给药方案暂停后继续治疗。50%的犬在发生 AKI 时接受了 6.9mg/kg 的两性霉素 D 累积剂量和 22.5mg/kg 的 ABLC 累积剂量（P<0.01）。入住 ICU（比值比[OR]0.21，95%置信区间[CI]：0.58-0.87）和住院状态（OR 0.25，95%CI：0.07-0.86）与 AKI 发生的可能性降低相关。