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Alexandra Andrade1, Sara GonÇalves Dias2, Ana Araújo Carvalho3, Rute Baeta Baptista4, Telma Francisco4, Margarida Abranches4

1 - Department of Paediatrics, Hospital Central Do Funchal, Funchal, Portugal
2 - Department Of Paediatrics, Hospital Divino Espírito Santo, São Miguel, Portugal
3 - Department Of Paediatrics, CHULC, Lisbon, Portugal
4 - Paediatric Nephrology Unit, Department of Paediatrics, CHULC, Lisbon, Portugal

- 54th ESPN Annual Meeting, Ljubljana, Slovenia, 22-25/06/2022, e-poster

Introduction: Nephrotoxicity is a common and potentially severe adverse effect associated with liposomal amphotericin B treatment.
Material and methods: We performed a cross-sectional analysis of data from all paediatric patients treated with liposomal amphotericin B in our centre from january/2017 to december/2021. We aimed to analyse the incidence of nephrotoxicity. The composite renal outcome was defined by the occurrence of AKI (creatinine rise >1.5x baseline) or tubulopathy (need for electrolyte replacement, glycosuria or polyuria).
Results: A total of 76 children were included, with a median age of 3.8 years (P25-P75: 1.2-10.3) and 50% were male. Median treatment duration was 10 days (P25-P75: 6-16). During the course of treatment, 17 (22%) patients died and 6 (8%) had to withdrawal treatment due to adverse effects. The composite renal outcome was achieved in 68 (89%) patients, with AKI occurring in 36 (47%) and tubulopathy in 58 (83%). Serum creatinine increased in 54 (71%) patients, rising 0.14 mg/dL (P25-P75: 0.05-0.5; range 0.01-2.28) or 44% (P25-P75: 16-168) above baseline. Peak creatinine was reached by day 7 (P25-P75 3-10; range 0-21) and returned to baseline by day 13 (P25-75: 6-16; range 0-32). Among the 56 (75%) who needed electrolyte replacement, maximum doses were 3.5 mEq of KCl/Kg/day (P25-P75: 2.0-5.4) and 5.5 mEq of NaCl/Kg/day (P25-P75: 3.0-13.0). Minimum serum potassium levels were significantly higher in patients with AKI (3.0 [P25-75: 2.9-3.1] versus 2.7 [2.5-3.0], p-value 0.04). No other significant differences were found. The presence of comorbidities was a significant predictor of tubulopathy in a logistic regression model adjusted for age, sex, and the severity of AKI (OR 5.9, CI95% 1.4-24.7, p-value 0.015).
Conclusions: Amphotericin B adverse effects led to treatment withdrawal in 8% of our cohort. Nephrotoxicity occurred in 89% of our patients and 75% needed electrolyte replacement. These data emphasize the need for serial clinical and laboratorial monitoring during treatment.

Keywords: Amphotericin B, hypokalemia, nephrotoxicity, tubulopathy