RENAL EFFECTS OF AMPHOTERICIN-B LIPID COMPLEX

A study was conducted to compare the renal effects of amphotericin B l ipid complex (ABLC), a lipid formulation of the widely used antifungal medication, with conventional amphotericin B (AmB) in the treatment o f serious fungal infections, including invasive candidiasis, cryptococ cal meningitis, and aspergillosis. The clinical experience of ABLC inc ludes two types of open-label studies: randomized comparative (ABLC 5 mg/kg/d compared with AmB 0.6 to 1 mg/kg) and emergency use. In the co mparative studies, changes in serum creatinine were evaluated three wa ys: doubling of the baseline value, an increase from less than or equa l to 1.5 mg/dL at baseline to greater than or equal to 1.5 mg/dL, and an increase from less than or equal to 1.5 mg/dL at baseline to greate r than or equal to 2.0 mg/dL. More patients in the AmB group reached t hese end points than in the ABLC group (P less than or equal to 0.007) , and the time needed to reach each of these end points was significan tly shorter for the AmB group (P less than or equal to 0.02). Increase d serum creatinine was reported as an adverse event more frequently by patients receiving AmB than by patients receiving ABLC. In the emerge ncy use study, a steady and statistically significant decrease in seru m creatinine was observed among patients who started ABLC treatment wi th serum creatinine greater than 2.5 mg/dL due to prior AmB treatment. ABLC offers the physician a valuable, less nephrotoxic alternative to AmB for the treatment of patients with severe, invasive fungal infect ions, (C) 1998 by the National Kidney Foundation, Inc.