Incidence of acute kidney injury in dogs with systemic mycotic infections treated with amphotericin B (1996‐2020)

Abstract Background Amphotericin‐B (AmB) is an essential medication for the treatment of life‐threatening systemic mycoses but the incidence and risk factors for acute kidney injury (AKI) after its administration are not known in dogs. Objective Determine the incidence of and risk factors for AKI in dogs receiving AmB. Animals Fifty‐one client owned dogs receiving AmB for the treatment of systemic mycoses. Methods Retrospective study. Signalment, potential risk factors, AKI development (creatinine ≥0.3 mg/dL from baseline), drug formulation (deoxycholate [AmB‐D] or lipid complex [ABLC]), dose, and treatment duration were recorded. The probability of an AKI diagnosis was evaluated using a log‐rank test. The incidence of AKI and odds ratios were calculated for potential risk factors. Results Incidence of AKI was 5/12 (42%) for dogs receiving AmB‐D and 14/39 (36%) for dogs receiving ABLC. Of the 19 dogs that developed AKI, 16 (84%) continued treatment after a pause in the planned dosing protocol. Fifty percent of dogs received a cumulative dose of 6.9 mg/kg for AmB‐D and 22.5 mg/kg for ABLC (P < .01) at time of AKI diagnosis. ICU hospitalization (odds ratio [OR] 0.21, 95% confidence interval [CI]: 0.58‐0.87) and inpatient status (OR 0.25, 95% CI: 0.07‐0.86) were associated with decreased odds of AKI. Conclusions and Clinical Importance Incidence of AKI with AmB is common but does not always preclude continued treatment. The incidence of AKI is similar between AmB‐D and ABLC, but dogs receiving ABLC tolerated a higher cumulative total dose before AKI diagnosis.