Comparative analysis of the nephrotoxicity of liposomal amphotericin B and amphotericin B lipid complex in hematological cancer patients: A multicenter retrospective study

Abstract

Background: The incidence rates of acute kidney injury (AKI) associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) are inconsistent across studies.

Aims: This study aimed to assess the AKI incidence rates in the largest cohort of patients undergoing ABLC and L-AMB treatment for invasive fungal diseases (IFD) in individuals with hematological cancers.

Methods: This was a multicenter, international, retrospective cohort study involving patients treated with either L-AMB or ABLC for IFD. All patients had a diagnosed malignant hematological disease. Various clinical and epidemiological variables were examined, including the concurrent use of nephrotoxic drugs. The primary outcome was the incidence of AKI.

Results: A total of 637 patients were included in the study, with 294 patients in the ABLC group and 343 patients in the L-AMB group. The most common diagnosis was acute leukemia (56%), followed by lymphoma (22%). The predominant classification of IFD was probable (43%). ABLC was associated with an increased likelihood of inducing grade 1 and 2 nephrotoxicity compared to L-AMB (p<0.001). Multivariate analysis identified age, vancomycin, and polymyxin use as independent risk factors for AKI. However, serum creatinine levels returned to baseline in 95.3% of patients.

Conclusion: Nephrotoxicity associated with L-AMB was lower than that associated with ABLC in patients with hematological cancer. Most AKI cases were mild to moderate and did not have significant short-term impact.

Keywords: Amphotericin B; Anfotericina B; Cancer; Cáncer; Fallo renal; Fungal infection; Infección fúngica; Nefrotoxicidad; Nephrotoxicity; Renal failure.