Clinical significance of nephrotoxicity in patients treated with amphotericin B for suspected or proven aspergillosis

The records of 239 immunosuppressed patients receiving amphotericin B for s uspected or proven aspergillosis were reviewed to determine rates of nephro toxicity, dialysis, and fatality, The mean and median durations of treatmen t were 20.4 and 15.0 days, respectively. The creatinine level doubled in 53 % of patients and exceeded 2.5 mg/dL in 29%; 14.5% underwent dialysis; and 60% died. A multivariate Cox proportional hazards analysis showed that pati ents whose creatinine level exceeded 2.5 mg/dL (hazard ratio [HR], 42.02; P < .001), allogeneic bone marrow transplantation (BMT) patients (HR, 6.34; P < .001), and autologous BMT patients (HR, 5.06; P = .024) were at greates t risk for requiring hemodialysis, Use of hemodialysis (HR, 3.089; P < .001 ), duration of amphotericin B use (HR, 1.03 per day; P = .015), and use of nephrotoxic agents (HR, 1.96; P = .017) were associated with greater risk o f death, whereas patients undergoing solid organ transplantation were at lo west risk (HR, 0.46; P = .002). These data indicate that elevated creatinin e levels during amphotericin a treatment are associated with a substantial risk for hemodialysis and a higher mortality rate, but the risks vary in di fferent patient groups.