TY - JOUR
T1 - Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven aspergillosis
AU - Wingard, John R.
AU - Kubilis, Paul
AU - Lee, Lily
AU - Yee, Gary
AU - White, Mary
AU - Walshe, Louise
AU - Bowden, Raleigh
AU - Anaissie, Elias
AU - Hiemenz, John
AU - Lister, John
N1 - Funding Information:
Received 7 August 1998; revised 14 April 1999. Grant support: This work was supported in part by a grant from The Liposome Company, Princeton, New Jersey. Reprints or correspondence: Dr. John R. Wingard, University of Florida College of Medicine, Department of Medicine, Division of Hematology/ Oncology, P.O. Box 100277, JHMHC, Gainesville, FL 32610-0277 (wingajr @medicine.ufl.edu).
PY - 1999
Y1 - 1999
N2 - 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 B treatment are associated with a substantial risk for hemodialysis and a higher mortality rate, but the risks vary in different patient groups.
AB - 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 B treatment are associated with a substantial risk for hemodialysis and a higher mortality rate, but the risks vary in different patient groups.
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U2 - 10.1086/313498
DO - 10.1086/313498
M3 - Article
C2 - 10585786
AN - SCOPUS:0033376314
SN - 1058-4838
VL - 29
SP - 1402
EP - 1407
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -