Abstract：
BACKGROUND: Acute kidney injury (AKI) and hypokalaemia are common adverse events after treatment with liposomal amphotericin B (L-AMB).
OBJECTIVE: 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.
CONCLUSIONS: 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.
OBJECTIVE: 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.
CONCLUSIONS: 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.
摘要：
背景：急性肾损伤（AKI）和低钾血症是脂质体两性霉素B（L-AMB）治疗后常见的不良事件。
目的：由于在L-AMB引起的肾小管损伤期间会发生过量的钾（K）泄漏，与从单点测量中确定的低钾血症相比,测量血清K浓度下降率可能更有助于评估L-AMB对肾脏的影响。研究了K浓度降低和低钾血症持续时间对AKI的影响。
方法：评估在7天时间范围内K浓度从参考浓度降低≥10%。低钾血症指数,其中结合了K浓度低于参考值的持续时间和明显的低K浓度，从浓度曲线上的面积计算。
结果：研究中纳入了86例患者。AKI发生率和钾浓度下降率分别为36.0%和63.9%，分别。在发生两种不良事件的患者中，在26例患者中，有22例患者首先出现了钾浓度的下降，7天后出现AKI。低钾血症不会增加AKI风险，而钾浓度降低是AKI的独立危险因素。AKI患者的低钾血症指数明显高于无AKI患者(5.35vs.2.50分,p=0.002),≥3.45分是AKI的显著预测因子。
结论：在接受L-AMB治疗的患者中，钾浓度下降≥10%是AKI的重要因素。在这样的病人中,可根据低钾血症指数考虑减量或替代抗真菌药物.
目的：由于在L-AMB引起的肾小管损伤期间会发生过量的钾（K）泄漏，与从单点测量中确定的低钾血症相比,测量血清K浓度下降率可能更有助于评估L-AMB对肾脏的影响。研究了K浓度降低和低钾血症持续时间对AKI的影响。
方法：评估在7天时间范围内K浓度从参考浓度降低≥10%。低钾血症指数,其中结合了K浓度低于参考值的持续时间和明显的低K浓度，从浓度曲线上的面积计算。
结果：研究中纳入了86例患者。AKI发生率和钾浓度下降率分别为36.0%和63.9%，分别。在发生两种不良事件的患者中，在26例患者中，有22例患者首先出现了钾浓度的下降，7天后出现AKI。低钾血症不会增加AKI风险，而钾浓度降低是AKI的独立危险因素。AKI患者的低钾血症指数明显高于无AKI患者(5.35vs.2.50分,p=0.002),≥3.45分是AKI的显著预测因子。
结论：在接受L-AMB治疗的患者中，钾浓度下降≥10%是AKI的重要因素。在这样的病人中,可根据低钾血症指数考虑减量或替代抗真菌药物.
