Non-Interventional, Retrospective, Multicenter Study on the Renal Safety of Liposomal Amphotericin B in Critically Ill Patients with Invasive Pulmonary Aspergillosis

Purpose: This study aims to determine the incidence of kidney injury associated with liposomal amphotericin B (L-AmB) treatment, based on RIFLE criteria, in patients admitted to the intensive care unit (ICU) with invasive pulmonary aspergillosis (IPA). Materials and Methods: A retrospective, multicenter observational study including patients treated with L-AmB for IPA while admitted to the ICU between 1 January 2015, and 31 December 2022. Results: A total of 65 patients were included. The prevalence of renal failure was 35.39%. Renal failure was mostly mild and reversible. The need for major surgery (OR 6.71; p = 0.121) and concomitant use of other nephrotoxic treatments (OR 2.5; p = 0.194) emerged as potential risk factors for the development of renal failure; however, neither association reached statistical significance. Overall mortality was 66.2%, significantly higher in the group with renal failure (82.6% vs. 57.1%; p = 0.03). Factors associated with mortality included concomitant use of other nephrotoxic agents (OR 4.51; p = 0.024) and development of renal failure (OR 3.66; p = 0.068). Duration of L-AmB treatment was not associated with mortality. Regarding creatinine recovery, all patients who developed renal failure but survived showed creatinine levels below 1.5 mg/dL after completion of treatment. Conclusions: Renal impairment was common in this high-risk population of critically ill patients, with renal function impairment in one-third of exposed patients, although most cases were mild. In this population, concomitant administration of other nephrotoxic drugs was associated with both renal failure and mortality. Treatment duration with L-AmB was not linked to mortality, and creatinine levels normalized after therapy completion.