Association between potassium supplementation and the occurrence of acute kidney injury in patients with hypokalemia administered liposomal amphotericin B: a nationwide observational study

Background: Hypokalemia and acute kidney injury (AKI) occur in patients administered liposomal amphotericin B (L-AMB), a wide-spectrum anti-fungicidal drug. However, the association between potassium supplementation and the occurrence of AKI in patients with hypokalemia who were administered L-AMB is not well understood.Methods: Using nationwide claims data and laboratory data, the occurrence of AKI during L-AMB treatment was retrospectively compared between patients with hypokalemia who were or were not supplemented with potassium and between those adequately or inadequately supplemented with potassium (serum potassium levels corrected to ≥3.5 mEq/L or remained < 3.5 mEq/L, respectively) before or after L-AMB treatment initiation.Results: We identified 118 patients who developed hypokalemia before L-AMB treatment initiation (43 received potassium supplementation [25 adequate and 18 inadequate supplementation] and 75 did not receive potassium supplementation), and 117 patients who developed hypokalemia after L-AMB initiation (79 received potassium supplementation [including 23 adequate and 15 inadequate supplementation] and 38 did not receive potassium supplementation). The occurrence of any stage of AKI was similar between patients with hypokalemia, regardless of potassium supplementation (i.e., before L-AMB treatment initiation [supplementation, 51%; non-supplementation, 45%; P = 0.570] or after L-AMB initiation [supplementation, 28%; non-supplementation, 32%; P = 0.671]). After adjusting for confounding factors, we found that the occurrence of any stage of AKI was not associated with potassium supplementation before L-AMB initiation (odds ratio [OR]: 1.291, 95% confidence interval [CI]: 0.584–2.852, P = 0.528) or after L-AMB initiation (OR: 0.954, 95% CI: 0.400–2.275, P = 0.915). The occurrence of any stage of AKI tended to decline in patients with hypokalemia who were adequately supplemented with potassium (44%) before, but not after, L-AMB initiation relative to that in patients inadequately supplemented with potassium (61%), however this result was not significant (P = 0.358).Conclusion: Potassium supplementation was not associated with any stage of AKI in patients with hypokalemia who were administered L-AMB

Efficacy of early administration of liposomal amphotericin B in patients with septic shock: A nationwide observational study

Introduction: Liposomal amphotericin B (L-AMB), a broad spectrum anti-fungicidal drug, is often administered to treat invasive fungal infections (IFIs). However, the most suitable time to initiate treatment in septic shock patients with IFI is unknown.Methods: Patients with septic shock treated with L-AMB were identified from the Japanese Diagnosis Procedure Combination national database and were stratified according to L-AMB treatment initiation either at septic shock onset (early L-AMB group) or after the onset (delayed L-AMB group) to determine their survival rates following septic shock onset and the shock cessation period.Results: We identified 141 patients administered L-AMB on the day of or after septic shock onset: 60 patients received early treatment, whereas 81 patients received delayed treatment. Survival rates after septic shock onset were higher in the early L-AMB group than in the delayed L-AMB group (4 weeks: 68.4% vs 57.9%, P = 0.197; 6 weeks: 62.2% vs 44.5%, P = 0.061; 12 weeks: 43.4% vs 35.0%, P = 0.168, respectively). The septic shock cessation period was shorter in the early L-AMB group than in the delayed L-AMB group (7.0 ± 7.0 days vs 16.5 ± 15.4 days, P < 0.001), with a significant difference confirmed after adjusting for confounding factors with propensity score matching (7.1 ± 7.2 days vs 16.7 ± 14.0 days, P = 0.001).Conclusion: Early L-AMB administration at septic shock onset may be associated with early shock cessation

シガ イカ ダイガク イガクブ フゾク ビョウイン ニオケル オーラル マネージメント システム ノ リンショウテキ ケントウ

当科では2014年から周術期口腔機能管理を目的に「オーラルマネージメントシステム」を稼働させている．2015年には患者に快適，安心，安全な周術期環境を提供することを目的とした，麻酔科医,薬剤師,歯科医師,歯科衛生士,看護師，管理栄養士,言語聴覚士など多職種からなる「周術期管理チーム」が発足し，当科はそのチームの一員として「オーラルマネージメントシステム」を使った口腔機能管理を担っている．今回われわれは，このシステムを利用して全身麻酔手術前の周術期口腔機能管理を実施した患者数の推移および依頼状況を把握するため臨床的検討を行った. 当院における2019年度の周術期口腔機能管理実施件数は1377件と2015年から比較して約1.6倍に増加し,実施率も34.5％と増加を認めた. 院内での啓蒙活動により,多職種における人々の口腔内に関する意識が高まり,周術期口腔機能管理実施件数や実施率の増加に繋がったと考えられた. その一方でマンパワーやチェア台数の不足などの課題も明らかとなった. 今回の調査結果を元に今後もシステムの発展に尽力する予定である.Since 2014, the Department of Oral and Maxillofacial Surgery at the Shiga University of Medical Science Hospital has been running an ‟Oral management system” specialized for oral management in the perioperative period. In 2015, the ‟Perioperative management team” was formed with the aim of providing a safe perioperative environment for patients. The team comprises anesthesiologists, pharmacists, dentists, dental hygienists, nurses, dietitians, speech pathologists, and other professionals, and manages the oral functions of patients. In this study, we report the statuses of requests and rate of adoption of the ‟Oral management system” in every department. In 2019, the number of cases of perioperative oral function management in our hospital was 1,377, an increase of about 1.6 times compared to 2015, and the implementation rate also increased to 34.5%. The educational activities in the hospital increased the awareness of the oral health of people in many professions, and led to an increase in the number and rate of perioperative oral function management. On the other hand, issues such as the lack of manpower and the number of chairs became apparent. Based on the results of this survey, we plan to continue our efforts to develop the system

Factor analysis of acute kidney injury in patients administered liposomal amphotericin B in a real-world clinical setting in Japan

Liposomal amphotericin B (L-AMB) is a broad-spectrum antifungal drug that is used to treat fungal infections. However, clinical evidence of its use in patients with renal failure is limited. Here, we aimed to identify factors associated with acute kidney injury (AKI) in patients administered L-AMB. We retrospectively utilized a combination of Diagnosis Procedure Combination data and laboratory data obtained from hospitals throughout Japan between April 2008 and January 2018. In total, 507 patients administered L-AMB were identified. After L-AMB treatment initiation, AKI, which was defined as a???1.5-fold increase within 7 days or???0.3 mg/dL increase within 2 days in serum creatinine according to the KDIGO criteria, was recognized in 37% of the total patients (189/507). The stages of AKI were stage 1 in 20%, stage 2 in 11%, and stage 3 in 7%. Five factors were associated with AKI of all stages: prior treatment with angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers or carbapenem; concomitant administration of catecholamines or immunosuppressants; and???3.52 mg/kg/day of L-AMB dosing. Serum potassium?<?3.5 mEq/L before L-AMB therapy was associated with severe AKI of stage 2 and 3. Altogether, these factors should be carefully considered to reduce the occurrence of AKI in patients administered L-AMB