Incidence, Predictors and Impact of Amphotericin B Nephrotoxicity on Hospital Mortality using Newer AKI Diagnostic Criteria.
Antimicrob Agents Chemother. 2015 May 26;
Authors: Rocha PN, Kobayashi CD, Almeida LC, Dos Reis CO, Santos BM, Glesby MJ
Abstract
Studies on amphotericin B (AmB) nephrotoxicity use diverse definitions of acute kidney injury (AKI). Herein, we used the new KDIGO system to describe the incidence, predictors and impact of AmB-induced AKI on hospital mortality in 162 patients treated with AmB (120 deoxycholate and 42 liposomal). KDIGO stage 1 requires an absolute increase ≥ 0.3 mg/dl or ≥ 1.5x over baseline serum creatinine (SCr); stage 2 ≥ 2x, and stage 3 ≥ 3x. A binary KDIGO definition (KDIGObin) corresponds to stage ≥ 1. For comparison, we included two definitions of AKI traditionally utilized in nephrotoxicity studies: ≥ 0.5 mg/dl (NT0.5) and ≥ 2x (NT2x) increase in baseline SCr. The overall incidence of AmB-induced AKI by KDIGObin was 58.6% (staged as: 1 = 30.9%; 2 = 18.5% and, 3 = 9.3%). Predictors of AKI by KDIGObin were older age and use of furosemide and ACE-I. Traditional criteria detected lower incidences of AKI: 45.1% (NT0.5) and 27.8% (NT2x). Predictors of AKI by traditional criteria were older age and use of vancomycin (NT0.5) and use of vancomycin and vasopressors (NT2x). KDIGObin detected AKI 2 days earlier than the most sensitive traditional criteria. However, only traditional criteria were associated with ICU admission, mechanical ventilation and mortality. In conclusion, the increase in sensitivity of KDIGObin is accompanied by a loss of specificity and ability to predict outcomes. Prospective studies are required to weigh the potential gain from early AKI detection against the potential loss from undue changes in management in patients with subtle elevations in SCr.
PMID: 26014956 [PubMed - as supplied by publisher]