Risk factors for Amphotericin B Nephrotoxicity among children six months to eighteen years old admitted at the Philippine Children’s Medical Center.
- Author:
Diosemil L. Leyson-Guzman
;
Alona A. Briones
;
Maria Rosario S. Cruz
;
Ma. Norma V. Zamora
;
Rachelle C. Dela Cruz
- Publication Type:Journal Article
- Keywords:
Nephrotoxicity;
Risk factors
- MeSH:
Amphotericin B
- From:
The Philippine Children’s Medical Center Journal
2019;15(1):44-52
- CountryPhilippines
- Language:English
-
Abstract:
BACKGROUND:Amphotericin B is used in pediatrics for severe fungal infections despite its known
nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk
factors that predispose children to developing these complications still undefined.
OBJECTIVES:To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B
treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017
METHODS:This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at
least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not
develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models.
RESULTS:Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and
nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity.
CONCLUSION:Risk factors for nephrotoxicity were malignancy as an underlying medical condition,
duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal
nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing
nephrotoxicity.
RECOMMENDATIONS:Clinicians should consider these risk factors, institute measures to monitor
occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With
identification of the population at risk, prospective research on determining the specific onset of renal
effects and possible intervention is recommended.
