Mortality and Costs of Acute Renal Failure Associated with Amphotericin B Therapy

Bates, D. W.
Su, L.
Yu, D. T.
Chertow, G. M.
Seger, D. L.
Gomes, D. R. J.
Dasbach, E. J.
Platt, R.

¹ Division of General Medicine, Boston
² Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston
³ Partners Information Systems, Boston
⁴ Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston
⁵ Merck & Co., Whitehouse Station, New Jersey
⁶ Divisions of Nephrology, Moffitt-Long Hospitals and University of California, San Francisco, Mt. Zion Medical Center, Department of Medicine, University of California, San Francisco

Received 10 April 2000; revised 10 July 2000; electronically published 21 February 2001.

This study was approved by the Human Research Committee of Brigham and Women's Hospital, Boston.

Financial support: Merck & Co., Inc.

Reprints or correspondence: Dr. David W. Bates, Division of General Medicine, Dept. of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115 ([email protected]).

1058-4838/2001/3205-0002$03.00

Clinical Infectious Diseases 32(5):p 686-693, March 1, 2001. | DOI: 10.1086/319211

To assess the mortality and resource utilization that results from acute renal failure associated with amphotericin B therapy, 707 adult admissions in which parenteral amphotericin B therapy was given were studied at a tertiary-care hospital. Main outcome measures were mortality, length of stay, and costs; we controlled for potential confounders, including age, sex, insurance status, baseline creatinine level, length of stay before beginning amphotericin B therapy, and severity of illness. Among 707 admissions, there were 212 episodes (30%) of acute renal failure. When renal failure developed, the mortality rate was much higher: 54% versus 16% (adjusted odds of death, 6.6). When acute renal failure occurred, the mean adjusted increase in length of stay was 8.2 days, and the adjusted total cost was $29,823. Although residual confounding exists despite adjustment, the increases in resource utilization that we found are large and the associated mortality is high when acute renal failure occurs following amphotericin B therapy.