Analysis of Nephrotoxicity and Hypokalemia during the Use of Liposomal Amphotericin B in Children with Febrile Neutropenia

Abstract

Purpose: Invasive fungal infections are an important cause of morbidity and mortality in children with febrile neutropenia. Although liposomal amphotericin B (L-AMB) is used safely due to its broad antifungal activity, it causes important side effects such as nephrotoxicity and hypokalemia. Methods: Medical records of 45 children with hematological malignancies who were given empirical L-AMB for febrile neutropenia between November 2011 and December 2019 were reviewed retrospectively. The estimated glomerular filtration rate (eGFR), serum creatinine and potassium levels were compared before and after 7th day of L-AMB treatment. Results: 62 febrile neutropenic attacks of 45 children were evaluated. The median age of the patients was 8.25 (3.5-13) years, and the number of attacks per patient was between 1-5. The median duration of treatment with L-AMB was 14 (range 9-21) days. Nephrotoxicity developed in 16 attacks (26%), and hypokalemia developed in 26 attacks (42%). In those who developed nephrotoxicity, eGFR was lower and creatinine level was higher after 7th day of L-AMB treatment, compared to their values before treatment. The frequency of hypokalemia was low in attacks where nephrotoxicity has been developed. High eGFR, and low creatinine level were risk factors with borderline significance from the point of development of nephrotoxicity. Conclusion: Potassium level should be carefully monitored and appropriate replacement therapy should be administered in febrile neutropenic children with hematological malignancy receiving L-AMB therapy. Parenteral hydration before L-AMB administration does not prevent nephrotoxicity, however it positively affects the frequency of nephrotoxicity.