Risk Factors for Nephrotoxicity Associated with Amphotericin B Deoxycholate Therapy

Therapy with amphotericin B deoxycholate can result in renal injury. The risk of nephrotoxicity is increased if certain factors are present.

Risk Factor	Action to Decrease Risk of Nephrotoxicity
pre-existing renal dysfunction	consider therapy with lipid amphotericin B or non-polyene antifungal
dehydration (hypovolemia)	hydrate
heart failure (relative hypovolemia)
third spacing (relative hypovolemia)
renal infection (adenovirus, CMV, other)
sepsis
therapy with concurrent nephrotoxins (see below)	avoid if possible, else carefully monitor renal function
total dose of amphotericin B > 500 mg
myeloma, amyloidosis, and/or light chain disease (due to renal disease)
tumor lysis syndrome	keep well hydrated and treat with allopurinol

Potential nephrotoxins:

(1) cyclosporin A

(2) tacrolimus

(3) foscarnet

(4) aminoglycosides

(5) radiocontrast imaging agents

(6) cis-platininum

(7) pentamidine

Reducing the risk of nephrotoxicity:

(1) slow infusion over 24 hours

(2) salt loading (infusion of normal saline) if able to tolerate salt and fluid load (500 mL before, addition after)

To read more or access our algorithms and calculators, please log in or register.