Document Detail


Proteinuria lowers the risk of amphotericin B-associated hypokalaemia.
MedLine Citation:
PMID:  17597057     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Amphotericin B-induced nephrotoxicity is frequent, severe and associated with an increased risk of death. Patients with underlying renal disease are considered to be at high risk for amphotericin B nephrotoxicity. Amphotericin B is a molecule that is highly protein bound over a wide range of protein and drug concentrations, including those seen in patients with >or= 3 + proteinuria. We hypothesized that amphotericin B treatment in patients with proteinuria will be associated with less hypokalaemia than patients with non-proteinuric renal disease. METHODS: Thirty-six subjects who received amphotericin B deoxycholate were studied retrospectively. Twenty-five patients with proteinuria < 3 g/L and 11 with proteinuria >or= 3 g/L were compared. RESULTS: Hypokalaemia (K+ < 3.5 mmol/L) developed in 47.2% (17/36) of our cohort of patients. There was a 64% (16/25) incidence of hypokalaemia in the group with < 3 g/L of proteinuria in contrast to an incidence of 9.1% (1/11) in the other group. CONCLUSIONS: In our study, heavy proteinuria appears to protect the tubular luminal membrane by decreasing the luminal concentration of free drug available to bind with the membrane. Our findings redefine the patient population deemed to be at risk of developing amphotericin B nephrotoxicity. This ensures the benefit of this important antifungal treatment option to patients with heavy proteinuria who might otherwise not be administered this drug due to the presence of pre-existing kidney disease.
Authors:
Sumit Mohan; Saud Ahmed; Behzad Alimohammadi; Manasvi Jaitly; Jen-Tse Cheng; Velvie A Pogue
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Publication Detail:
Type:  Journal Article     Date:  2007-06-27
Journal Detail:
Title:  The Journal of antimicrobial chemotherapy     Volume:  60     ISSN:  0305-7453     ISO Abbreviation:  J. Antimicrob. Chemother.     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-16     Completed Date:  2007-12-10     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7513617     Medline TA:  J Antimicrob Chemother     Country:  England    
Other Details:
Languages:  eng     Pagination:  690-3     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, Harlem Hospital Center, Columbia, University College of Physicians and Surgeons, 506 Lenox Avenue, Room 12101, New York, NY 10037, USA. sm2206@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Amphotericin B / adverse effects*,  pharmacokinetics,  therapeutic use
Antifungal Agents / adverse effects*,  pharmacokinetics,  therapeutic use
Female
Humans
Hypokalemia / chemically induced*,  urine*
Kidney Diseases / complications,  metabolism
Male
Middle Aged
Mycoses / complications,  drug therapy
Proteinuria / metabolism*
Retrospective Studies
Risk
Chemical
Reg. No./Substance:
0/Antifungal Agents; 1397-89-3/Amphotericin B

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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