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Comparative analysis of the nephrotoxicity of liposomal amphotericin B and amphotericin B lipid complex in hematological cancer patients: A multicenter retrospective study

Edinger S.; Abdala E.; Ertürk U.Ş.; Çelik S.; Kaynar L.; Rabagliati R.; Badali H.; Amanati A.; Ruiz A.M.H.; Meletiadis J.; Stamouli M.; Ramos J.F.; Schwarzbold A.V.; Caeiro J.P.; Giordano G.N.; Gamaletsou M.N.; Ferrari L.F.; Telles J.P.; Tuon F.F.; Guarita-Souza L.C. · Revista Iberoamericana de Micologia (2025) · DOI: 10.1016/j.riam.2025.04.003

Resumen

Background: The incidence rates of acute kidney injury (AKI) associated with amphotericin B lipid complex (ABLC) and liposomal amphotericin B (L-AMB) are inconsistent across studies. Aims: This study aimed to assess the AKI incidence rates in the largest cohort of patients undergoing ABLC and L-AMB treatment for invasive fungal diseases (IFD) in individuals with hematological cancers. Methods: This was a multicenter, international, retrospective cohort study involving patients treated with either L-AMB or ABLC for IFD. All patients had a diagnosed malignant hematological disease. Various clinical and epidemiological variables were examined, including the concurrent use of nephrotoxic drugs. The primary outcome was the incidence of AKI. Results: A total of 637 patients were included in the study, with 294 patients in the ABLC group and 343 patients in the L-AMB group. The most common diagnosis was acute leukemia (56%), followed by lymphoma (22%). The predominant classification of IFD was probable (43%). ABLC was associated with an increased likelihood of inducing grade 1 and 2 nephrotoxicity compared to L-AMB (p < 0.001). Multivariate analysis identified age, vancomycin, and polymyxin use as independent risk factors for AKI. However, serum creatinine levels returned to baseline in 95.3% of patients. Conclusion: Nephrotoxicity associated with L-AMB was lower than that associated with ABLC in patients with hematological cancer. Most AKI cases were mild to moderate and did not have significant short-term impact.