The clinical usage of liposomal amphotericin B in patients receiving renal replacement therapy in Japan: a nationwide ob
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ORIGINAL ARTICLE
The clinical usage of liposomal amphotericin B in patients receiving renal replacement therapy in Japan: a nationwide observational study Yoko Obata1 · Takahiro Takazono2,3 · Masato Tashiro2,4 · Yuki Ota1 · Tomotaro Wakamura5 · Akinori Takahashi6 · Kumiko Sato6 · Taiga Miyazaki2,3 · Tomoya Nishino1 · Koichi Izumikawa2,4 Received: 19 May 2020 / Accepted: 29 October 2020 © Japanese Society of Nephrology 2020
Abstract Background Liposomal amphotericin B (L-AMB), a broad-spectrum antifungicidal drug, is often used to treat fungal infections. However, clinical evidence of its use in patients with renal dysfunction, especially those receiving renal replacement therapy (RRT), is limited. Therefore, we evaluated the usage and occurrence of adverse reactions during L-AMB therapy in patients undergoing RRT. Methods Using claims data and laboratory data, we retrospectively evaluated patients who were administered L-AMB. The presence of comorbidities, mortality rate, treatment with L-AMB and other anti-infective agents, and the incidence of adverse reactions were compared between patients receiving RRT, including continuous renal replacement therapy (CRRT) and maintenance hemodialysis (HD), and those that did not receive RRT. Results In total, 900 cases met the eligibility criteria: 24, 19, and 842 cases in the maintenance HD, CRRT, and non-RRT groups, respectively. Of the patients administered L-AMB, mortality at discharge was higher for those undergoing either CRRT (15/19; 79%) or maintenance HD (16/24; 67%) than for those not receiving RRT (353/842; 42%). After propensity score matching, the average daily and cumulative dose, treatment duration, and dosing interval for L-AMB were not significantly different between patients receiving and not receiving RRT. L-AMB was used as the first-line antifungal agent for patients undergoing CRRT in most cases (12/19; 63%). Although the number of subjects was limited, the incidence of adverse events did not markedly differ among the groups. Conclusion L-AMB may be used for patients undergoing maintenance HD or CRRT without any dosing, duration, or interval adjustments. Keywords Liposomal amphotericin B · Maintenance hemodialysis · Continuous renal replacement therapy · Renal replacement therapy · Renal dysfunction
Introduction Invasive fungal infections frequently occur in immunocompromised and critically ill patients and are associated with high morbidity and mortality [1–5]. Amphotericin B is a * Yoko Obata yobata‑[email protected] 1
Department of Nephrology, Nagasaki University Hospital, 1‑7‑1 Sakamoto, Nagasaki 852‑8501, Japan
2
Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1‑7‑1 Sakamoto, Nagasaki 852‑8501, Japan
3
Department of Respiratory Medicine, Nagasaki University Hospital, 1‑7‑1 Sakamoto, Nagasaki 852‑8501, Japan
broad-spectrum antifungicidal drug that is used against most clinically relevant yeasts and molds that cause mycoses such as aspergillosis, candidiasis, cryptococcosis, and mucormy
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