Efficacy of fluid infusions on the recovery from acute kidney injury in patients administered liposomal amphotericin B: A nationwide observational study

Abstract

Background: Acute kidney injury (AKI) often develops during the administration of liposomal amphotericin B (L-AMB), a broad-spectrum antifungal drug. However, clinical recovery approaches for AKI patients administered L-AMB have not been well established.Methods: A retrospective analysis was conducted using data obtained from hospitals throughout Japan. AKI was defined as a ≥1.5-fold increase within 7 days or ≥0.3 mg/dL increase within 2 days in serum creatinine. Renal recovery was defined as a return to creatinine levels below those recorded before the onset of AKI.Results: Herein, 189 patients had developed AKI following L-AMB administration. Of them, 153 were subsequently assessed to determine the trend in creatinine level after AKI and 90 patients were assessed for renal recovery. Patients administered ≥10 mL/kg daily fluid for 7 consecutive days from the onset of AKI had a 63% recovery rate relative to patients that did not receive infusion (35% recovery rate (P = 0.053)). Although extending the fluid infusion period beyond 7 days did not result in consistent improvement in renal recovery rates, daily fluid volume was found to be positively correlated with renal recovery (P = 0.043). On average, patients administered daily fluid infusions of ≥10 mL/kg had greater reductions in minimum creatinine levels for the first 7 days after AKI compared to patients that did not receive daily fluid infusions. After 7 days of fluid infusion, the mean minimum creatinine levels decreased by 0.21 mg/dL relative to 0.16 mg/dL for patients that did not receive daily fluid infusions.Conclusions: Seven consecutive days of daily fluid infusion from the onset of AKI may promote renal recovery from AKI in patients administered L-AMB, with daily fluid volume positively correlating with the incidence of renal recovery.