Neonatal fluid and electrolytes profile effect on amphotericin B associated nephrotoxicity in neonatal tertiary care unit of Karachi-Pakistan

ABSTRACT

Objectives

Amphotericin-B (d-AmB) has a broader anti-fungal spectrum and is used for neonatal invasive-fungal-infections especially invasive-candidiasis (IC). To prevent d-AmB-induced nephrotoxicity, renal protective effect of fluid and electrolyte management has been established among adults; in this study, the authors determined this effect among neonates.

Methods

In this retrospective cohort study, the authors reviewed neonatal medical records, admitted to neonatal intensive care unit and received d-AmB therapy. Patients were divided into, renal-insufficiency-group (RIG) and the non-renal-insufficiency-group (NIG).

Results

A total of 90 cases were analyzed, 41 composed RIG and 49 NIG. Renal insufficiency (RI) was developed on 1.7 (0.84) and 7.8 (1.21) days of d-AmB therapy in 26 (63%) and 15 (37%) cases respectively. Bivariate and multivariate analysis demonstrate that >4 m Eq/kg/d sodium intake across all-time points was significantly (p < 0.0001) associated with reduced risk of RI [(phase-I: AOR: 0.96; 95% CI: 0.91–0.99), (phase-II: AOR: 0.84; 95% CI: 0.68–0.92) and (phase-III: AOR: 0.90; 95% CI: 0.86–0.95)]. While adequate fluid intake reduced the likelihood of RI if started before and initial 2 days of d-AmB therapy.

Conclusions

Adequate hydration before and 48 hours after d-AmB therapy and >4 mEq/kg/day sodium intake before and through d-AmB therapy may protect neonatal RI.

KEYWORDS:

• Amphotericin B
• nephrotoxicity
• neonates
• sodium
• potassium
• neonates
• fluid and electrolytes

Authors’ contributions

Gul Ambreen: substantial contributions to the conception or design of the work. Performed the study and wrote the paper. Arshalooz Rehman: supervised the research, and gave final approval of the version published. Kashif Hussain: supervised the research, and gave final approval of the version published. Mehreen Sohail: drafted the work and revised it critically for important intellectual content in the revision phase. Syed Shamim Raza: support in conduction of the study, paper review, and editing. Umer Ali: support in conduction the study, paper review, and editing. Khalil Ahmad: paper review and final approval of the version published. Arjumand Rizvi: analysis or interpretation of data. Saba Javed: worked on manuscript while responding to reviewers’ comments.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.