Effect of salt supplementation on amphotericin B nephrotoxicity.

Abstract

It has been suggested that salt loading protects against amphotericin B-induced nephrotoxicity. The influence of saline loading on the nephrotoxic response to amphotericin B (50 mg/dose given i.v. over 4 hr 3 X/week for 10 weeks) was assessed in two groups of ten patients each who were diagnosed with mucocutaneous leishmaniasis. Patients were randomized to receive either 1 liter of 0.9% saline or 1 liter of 5% dextrose in water, administered i.v. over one hour in a double-blinded manner, directly prior to amphotericin B administration. Renal function was monitored on a weekly basis two days after the last dose of amphotericin B. Baseline characteristics were similar in both groups except for a slightly higher serum creatinine concentration (Cr) in the saline group (0.8 +/- 0.05 vs. 0.6 +/- 0.04 mg/dl). Baseline sodium (Na) excretion was relatively high (262 +/- 23 mmol/day in the dextrose group and 224 +/- 17 mmol/day in the saline group). None of the patients sustained an increase in Cr to values greater than 1.7 mg/dl. Although mean Cr remained within normal, there was a significant difference between the two groups over the ten week period, with the dextrose group sustaining a significant increase in Cr and the saline group remaining unchanged. Serum potassium (K) levels fell in both groups necessitating oral K supplementation. The saline group required significantly greater amounts of K supplementation to maintain a normal serum K. Amphotericin B caused a rapid reduction in the acidification ability of the kidney in response to an ammonium chloride load. Under these conditions, the saline group had a poorer ability to acidify the urine.(ABSTRACT TRUNCATED AT 250 WORDS)

• Authors: A Llanos, J Cieza, J Bernardo, J Echevarria, I Biaggioni, R Sabra, R A Branch
• Journal: Kidney international (Kidney Int) Vol. 40 Issue 2 Pg. 302-8 (Aug 1991) ISSN: 0085-2538 [Print] United States
• PMID: 1942779 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Sodium Chloride
• Amphotericin B
• Creatinine
• Potassium

Topics

• Adolescent
• Adult
• Aged
• Amphotericin B (adverse effects, antagonists & inhibitors, metabolism)
• Creatinine (blood)
• Glomerular Filtration Rate (drug effects)
• Humans
• Kidney (drug effects, physiopathology)
• Leishmaniasis, Mucocutaneous (blood, drug therapy)
• Middle Aged
• Potassium (blood)
• Sodium Chloride (administration & dosage)