Association between the hypokalaemia index based on area over the serum potassium concentration curve and occurrence of acute kidney injury in patients administered liposomal amphotericin B.
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引用次数: 0
Abstract
Background: Acute kidney injury (AKI) and hypokalaemia are common adverse events after treatment with liposomal amphotericin B (L-AMB).
Objectives: Because excess potassium (K) leakage occurs during renal tubular injury caused by L-AMB, measuring the decrease in rate of serum K concentration might be more useful to assess the renal impact of L-AMB than hypokalaemia identified from a one-point measurement. The effects of a decrease in K concentration and duration of hypokalaemia on AKI were investigated.
Methods: A ≥ 10% decrease in K concentration from the reference concentration within a 7-day timeframe was evaluated. The hypokalaemia index, which combines the duration of K concentration lower than the reference and a marked low K concentration, was calculated from the area over the concentration curve.
Results: Eighty-six patients were included in the study. The incidences of AKI and decrease in K concentration were 36.0% and 63.9%, respectively. Of patients who developed both adverse events, a decrease in K concentration occurred first in 22 of 26 patients, followed by AKI 7 days later. Hypokalaemia did not increase AKI risk whereas a decrease in K concentration was an independent risk factor for AKI. The hypokalaemia index in patients with AKI was significantly higher than those without AKI (5.35 vs. 2.50 points, p = 0.002), and ≥3.45 points was a significant predictor for AKI.
Conclusion: A ≥ 10% decrease in the K concentration was a significant factor for AKI in patients receiving L-AMB therapy. In such patients, dose reduction or alternative antifungals could be considered based on the hypokalaemia index.
背景：急性肾损伤（AKI）和低钾血症是脂质体两性霉素 B（L-AMB）治疗后常见的不良反应：目的：由于L-AMB引起的肾小管损伤会导致过量的钾（K）渗漏，因此测量血清K浓度的下降速度可能比单点测量确定的低钾血症更有助于评估L-AMB对肾脏的影响。我们研究了 K 浓度下降和低钾血症持续时间对 AKI 的影响：方法：对 7 天内 K 浓度从参考浓度下降≥10% 的情况进行评估。低钾血症指数由 K 浓度低于参考值的持续时间和 K 浓度明显偏低的持续时间组成，根据浓度曲线上的面积计算得出：研究共纳入 86 名患者。AKI 和 K 浓度下降的发生率分别为 36.0% 和 63.9%。在出现这两种不良反应的患者中，26 名患者中有 22 名首先出现钾浓度下降，7 天后出现高钾血症。低钾血症不会增加急性肾功能损伤的风险，而钾浓度下降则是急性肾功能损伤的独立风险因素。发生 AKI 的患者的低钾血症指数明显高于未发生 AKI 的患者（5.35 点对 2.50 点，P = 0.002），≥3.45 点是发生 AKI 的重要预测因素：结论：K浓度下降≥10%是导致接受L-AMB治疗的患者发生AKI的重要因素。对于此类患者，可根据低钾血症指数考虑减少剂量或使用其他抗真菌药物。
期刊介绍：
The journal Mycoses provides an international forum for original papers in English on the pathogenesis, diagnosis, therapy, prophylaxis, and epidemiology of fungal infectious diseases in humans as well as on the biology of pathogenic fungi.
Medical mycology as part of medical microbiology is advancing rapidly. Effective therapeutic strategies are already available in chemotherapy and are being further developed. Their application requires reliable laboratory diagnostic techniques, which, in turn, result from mycological basic research. Opportunistic mycoses vary greatly in their clinical and pathological symptoms, because the underlying disease of a patient at risk decisively determines their symptomatology and progress. The journal Mycoses is therefore of interest to scientists in fundamental mycological research, mycological laboratory diagnosticians and clinicians interested in fungal infections.
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