Purpose Lipid-based Amphotericin B preparations have been developed to impr
ove drug targeting and reduce toxicity. Although increasingly used, little
published information is available on liposomal Amphotericin B (AmBisome) i
n children with established renal impairment on treatment for febrile neutr
openia. The purpose of this study was to examine the nephrotoxicity of AmBi
some in children with malignant disease with established renal impairment.
Patients and Methods This retrospective study examined 17 episodes of AmBis
ome use (3 mg/kg/day) in 14 febrile, neutropenic children with established
glomerular or tubular impairment. The findings are contrasted with results
from 25 episodes of Amphotericin B use (1 mg/kg/day) in 24 children with no
rmal renal function receiving antifungal treatment for similar reasons.
Results Mean creatinine was stable in patients receiving AmBisome but incre
ased significantly in those on Amphotericin B. Doubling of serum creatinine
was seen in no patient receiving AmBisome, in contrast to 20% of patients
on Amphotericin B. In both groups mean serum potassium was stable but potas
sium supplementation rose significantly. The rise in potassium supplementat
ion became significant earlier in the Amphotericin B group than in the AmBi
some group (day 2 vs. day 7). Despite the use of AmBisome, profound hypokal
aemia (< 2.5 mmol/I) occurred in 18% of patients.
Conclusions Further decline in glomerular function was rare in children wit
h cancer receiving AmBisome. Potassium wasting was seen with both AmBisome
and conventional Amphotericin B but in high-risk patients receiving AmBisom
e deterioration was similar to that occurring in children with normal renal
function receiving Amphotericin B.