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Abdel-Hafez Y, Siaj H, Janajri M, Abu-Baker Y, Nazzal Z, Hamdan Z, Adwan R, Aiesh BM, Anaya AI. Tolerability and epidemiology of nephrotoxicity associated with conventional amphotericin B therapy: a retrospective study in tertiary care centers in Palestine. BMC Nephrol 2022; 23:132. [PMID: 35382766 PMCID: PMC8982299 DOI: 10.1186/s12882-022-02770-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the light of recent years, an increase in the number of life-threatening infections due to various fungi has been observed, especially in tertiary care centres. With Amphotericin B labelled as the first choice in treating these infections, one of its common side effects, nephrotoxicity, along with hypokalemia, were studied to determine the epidemiology, risk factors, and protective measures. METHODOLOGY The study was a retrospective observational chart review study in which patients were receiving conventional Amphotericin B in two tertiary hospitals in Palestine from January 2018 to December 2020 were evaluated for the development of hypokalemia and nephrotoxicity; according to the KDIGO criteria. A total of 117 patients were included in the study. Patients who have received the drug intermittently, in fewer than two doses, through non-IV routes and patients under the age of 12 were excluded. The data collected included, but were not limited to, age, gender, comorbidities, Amphotericin B treatment details, medications, COVID-19 status, risk factors, and hypothesized protective measures. RESULTS The incidence of conventional Amphotericin B nephrotoxicity and hypokalemia was 46% and 33%, respectively. With a roughly equal representation of both genders and a median age of 52 years in a range of 13-89. No association between the variables and the development of nephrotoxicity was found. However, a 3.4 increased risk (p-value = 0.01) of developing hypokalemia in females compared to males was observed. CONCLUSION Our research has shown a relatively lower yet consistent, incidence of conventional amphotericin B nephrotoxicity and hypokalemia compared to literature with gender being a risk factor for developing hypokalemia.
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Affiliation(s)
- Yusri Abdel-Hafez
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hani Siaj
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mohammad Janajri
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazan Abu-Baker
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Community Medicine, Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Box 7, 707, Nablus, Palestine.
| | - Zakaria Hamdan
- Internal Medicine Department, An-Najah National University Hospital, Box 7, 707, Nablus, Palestine.
| | - Rabee Adwan
- Infectious Diseases Unit, Makassed Charitable Society Hospital, East Jerusalem, Palestine
| | - Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad I Anaya
- Internal Medicine Department, An-Najah National University Hospital, Nablus, Palestine
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Gursoy V, Ozkalemkas F, Ozkocaman V, Serenli Yegen Z, Ethem Pinar I, Ener B, Akalın H, Kazak E, Ali R, Ersoy A. Conventional Amphotericin B Associated Nephrotoxicity in Patients With Hematologic Malignancies. Cureus 2021; 13:e16445. [PMID: 34422476 PMCID: PMC8367387 DOI: 10.7759/cureus.16445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Amphotericin B (AmB-d) is one of the most effective therapeutic options against frequently life-threatening systemic fungal infections in patients with hematologic malignancies. However, significant adverse effects including nephrotoxicity associated with its use limit its more widespread use. The objectives of our study were to determine the incidence of AmB-d associated nephrotoxicity, to evaluate clinical and epidemiological characteristics of patients, and to support the notion that conventional amphotericin B remains a valid therapeutic option among hematologic patients with proper patient selection. Materials and methods: A total of 110 patients with hematologic malignancies were admitted to our Hematology Unit between January 2014 and November 2017 who required anti-fungal therapy during intensive systemic chemotherapy. The incidence of AmB-d associated nephrotoxicity, side effect profile, time to nephrotoxicity, and clinical and epidemiological characteristics associated with treatment success were assessed retrospectively. Results: Of the 110 patients receiving AmB-d, 70 (63.6%) were male and 40 (36.4%) were female. The mean age of participants was 44 years. The most common diagnosis was acute myeloid leukemia (n=53, 48.2%), and the most common chemotherapy protocol was 7 + 3 remission-induction (cytarabine 100 mg/m² days 1-7, Idarubicin 12 mg/m² days 1-3; n=24, 21.8%). In 56.4% of the patients, antifungal therapy was given empirically. In 40 patients (36.4%), nephrotoxicity was observed following antifungal treatment, and only four patients had stage 3 renal failure. The mean duration of time to nephrotoxicity from initiation of amphotericin B was four days (min: 2, max: 31). All patients were found to receive at least one additional potential nephrotoxic treatment during the antifungal treatment process. Conclusion: AmB-d is associated with a significant risk of nephrotoxicity. In most hematological patients, antifungal treatment is initiated empirically, and patients received prolonged courses of treatment. Therefore, it is plausible to initiate such treatment with AmB-d, when one considers the already high treatment costs in this patient group as well as the fact that AmB-d offers similar efficacy to antifungal agents at a lower cost. AmB-d may be recommended as a first-line agent in this patient group with the introduction of newer and more costly antifungal agents when needed, on the basis of the fact that these patients can be closely monitored in a hospital setting, reversible nature of nephrotoxicity upon discontinuation, and rare occurrence of severe renal failure requiring dialysis.
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Affiliation(s)
- Vildan Gursoy
- Division of Hematology, Department of Internal Medicine, Medical School of Usak University, Usak, TUR
| | - Fahir Ozkalemkas
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Vildan Ozkocaman
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | | | - Ibrahim Ethem Pinar
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Beyza Ener
- Department of Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Halis Akalın
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Esra Kazak
- Department of Infectious Diseases and Clinical Microbiology, Uludag University Medical Faculty, Bursa, TUR
| | - Ridvan Ali
- Division of Hematology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
| | - Alparslan Ersoy
- Division of Nephrology, Department of Internal Medicine, Uludag University Medical Faculty, Bursa, TUR
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Karimzadeh I, Jafari M, Davani-Davari D, Ramzi M. The Pattern of Cyclosporine Nephrotoxicity and Urinary Kidney Injury Molecule 1 in Allogenic Hematopoietic Stem Cell Transplant Patients. EXP CLIN TRANSPLANT 2020; 19:553-562. [PMID: 33272156 DOI: 10.6002/ect.2020.0123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The typical immunosuppressive regimen of hematopoietic stem cell transplant includes cyclosporine. However, cyclosporine nephrotoxicity is a concern. We studied cyclosporine nephrotoxicity epidemiology in hematopoietic stem cell transplant patients and compared the pattern and urinary levels of the KIM-1 kidney injury molecule versus serum and urine creatinine levels. MATERIALS AND METHODS The study covered 10 months at Namazi Hospital, Shiraz, Iran. All patients met the following criteria: > 15 years old, received allogenic hematopoietic stem cell transplant without history of acute or chronic kidney disease, and scheduled for at least 1 week of cyclosporine treatment. Urinary and serum levels of creatinine, urea, sodium, potassium, magnesium, and the KIM-1 kidney injury molecule were measured on days 0, 3, 5, 7, 10, and 14 of cyclosporine treatment. RESULTS Of 42 patients, one-third developed cyclosporine nephrotoxicity (30.95%), and median onset time was 15 days. Hypokalemia and hypomagnesemia were reported in 76.2% and 53.4% of the cohort, respectively. None of the demographic, clinical, and paraclinical parameters was significantly associated with cyclosporine nephrotoxicity. Median duration of hospital stay for patients with cyclosporine nephrotoxicity (41 days) was significantly higher (P < .001) than those without nephrotoxicity (29 days). Area under the curve for receiver operating characteristic showed that accuracy of serum creatinine (0.267; 95% CI, 0.11-0.43) at day 0 of cyclosporine treatment was significantly lower (P = .017) than the accuracy of urine creatinine (0.477; 95% CI, 0.28-0.67) and urine levels of the KIM-1 kidney injury molecule (0.594; 95% CI, 0.41-0.78). CONCLUSIONS Cyclosporine nephrotoxicity is a common adverse effect in the setting of hematopoietic stem cell transplant and occurs mostly within the first 2 weeks of cyclosporine treatment. Urine KIM-1 kidney injury molecule measurement had no overall superiority and no improved accuracy over serum or urine creatinine measurements for prediction or detection of cyclosporine nephrotoxicity.
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Affiliation(s)
- Iman Karimzadeh
- From the Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Karimzadeh I, Sepehr-Sobhani A, Khoshnoud MJ, Sagheb MM, Vejdani R, Jalali A, Mahi-Birjand M. Comparison of intravenous sodium bicarbonate and sodium chloride combination versus intravenous sodium chloride hydration alone in reducing amphotericin B nephrotoxicity: a randomized clinical trial. Res Pharm Sci 2020; 15:583-591. [PMID: 33828601 PMCID: PMC8020849 DOI: 10.4103/1735-5362.301343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/04/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background and purpose: The most important adverse reaction of amphotericin B (AmB) is nephrotoxicity. The aim of this study was to assess the potential effectiveness of intravenous saline + sodium bicarbonate versus intravenous sodium chloride hydration in preventing or attenuating AmB nephrotoxicity. Experimental approach: A randomized, non-placebo-controlled, single-blinded clinical trial was conducted in two adult hematology-oncology wards of Namazi hospital. Eligible patients were randomly assigned into either the normal saline or normal saline + sodium bicarbonate groups by the ratio of 1:2. In the normal saline group, 1000 mL of sodium chloride 0.9% (154 meq sodium) was given intravenously as two equal 500 mL volumes before and during the infusion of AmB. Patients in the saline + sodium bicarbonate group received 500 mL sodium chloride 0.9% (72 meq sodium) before and 500 mL isotonic sodium bicarbonate (72 meq sodium) intravenously during AmB infusion. Findings/Results: The rate of AmB nephrotoxicity was comparable between normal saline and sodium bicarbonate groups (54.2% and 41.6%, respectively; P = 0.3). This difference did not reach the level of statistical significance after considering AmB dose and duration of the treatment. The frequency of hypokalemia and hypomagnesemia did not differ significantly between the two groups even after adjusting the results according to AmB dose and treatment duration. Conclusion and implications: The results of the current preliminary clinical trial suggested that the combination of sodium bicarbonate and normal saline compared to normal saline alone appears to have no superiority in preventing or attenuating different studied aspects of AmB nephrotoxicity in patients with hematological malignancies.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Asma Sepehr-Sobhani
- Department of Pharmacology-Toxicology, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Mohammad Javad Khoshnoud
- Department of Pharmacology-Toxicology, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran.,Food and Supplements Research Center, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Mohammad Mahdi Sagheb
- Nephrology-Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, I.R. Iran
| | - Reza Vejdani
- Hematology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, I.R. Iran
| | - Atefeh Jalali
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Science, Shiraz, I.R. Iran
| | - Motahareh Mahi-Birjand
- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, I.R. Iran.,Department of Clinical Pharmacy, Faculty of pharmacy, Birjand University of Medical Sciences, Birjand, I.R. Iran
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Ambreen G, Rehman A, Hussain K, Sohail M, Javed S, Shamim S, Ali U, Ahmad K, Rizvi A. Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan. Expert Opin Drug Saf 2020; 19:1209-1217. [PMID: 32544349 DOI: 10.1080/14740338.2020.1781813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates. METHODS In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG). RESULTS A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91-0.99), (phase-II: AOR: 0.84; 95% CI: 0.68-0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86-0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy. CONCLUSIONS Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.
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Affiliation(s)
- Gul Ambreen
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Arshalooz Rehman
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Mehreen Sohail
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Saba Javed
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Syed Shamim
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Umer Ali
- Department of Pharmacy, Aga Khan University Hospital , Karachi, Pakistan
| | - Khalil Ahmad
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
| | - Arjumand Rizvi
- Department of Paediatrics and Child Health, Aga Khan University Hospital , Karachi, Pakistan
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