Nephrotoxicity mortality rates

Mucormycosis has an exceedingly high mortality rate in immunocompromised patients. In five phase I and phase II studies of ABCD, 21 patients were given ABCD (mean dose 4.8 mg/kg per infusion for a mean duration of 37 days) on the basis of pre-existing renal insufficiency, nephrotoxicity during amphotericin B therapy, or refractory infections (24). Of 20 evaluable patients, 12 responded to ABCD, and there was no renal or hepatic toxicity. However, a previous randomized, comparative trial showed an at least similar if not increased frequency... 

A novel approach to reducing the incidence of nephrotoxicity associated with radiocontrast dye administration is to provide RRT pro-phylacticaUy to patients at high risk. Hemofiltration provided prior to and 24 hours after dye administration resulted in significantly reduced mortality rates and a reduced need for dialysis. In contrast, the use of hemodialysis within an hour of contrast dye infusion did not yield an improvement in nephrotoxicity rates, possibly because the toxicity due to dye occurs within minutes of its administration. ... 

High mortality was reported in male rats that received 1,4-dichlorobenzene 5 days a week by gavage in com oil in a 2-year study (NTP 1987). At 300 mg/kg/day, 26 of 50 males (52%) died however, survival of female rats at 600 mg/kg/day was comparable to controls. There was no excess mortality in mice of either sex that received 1,4-dichlorobenzene 5 days a week by gavage in com oil for 2 years at levels up to 600 mg/kg/day (NTP 1987). The high rate of mortality in male rats was probably related, in part, to the severe nephrotoxic effects and renal tumors that were reported in these animals and are described in more detail in Sections 2.22.2 and 2.2.2.8. 

Nephrotoxicity associated with amphotericin B administration in humans is dose related and it may be severe and result in acute renal failure. The incidence of acute renal failure may be as high as 49 to 65%. It is accompanied by an increase in serum creatinine. Mortality may be high and is increased by the co-administration of other nephrotoxic drugs. Risk factors include cumulative dose, abnormal baseline renal function, concomitant nephrotoxic drugs such as cyclosporin, and infusion rates. However, rapid infusion rates are also associated with severe hyperkalaemia and potentially fatal arrhythmias. " In one case, a woman given 5mg/kgbw/day amphotericin B instead of the... 

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