Empiric Liposomal Amphotericin B Not Linked to AKI in Critically Ill COVID-19 Patients, Suggests Study
Spain: Researchers have found in a new study that empiric treatment with liposomal amphotericin B (L-AmB) appears safe in critically ill COVID-19 patients and was not associated with an increased incidence of acute kidney injury (AKI).
The retrospective cohort study, published in BMC Nephrology by Ángel Estella, Servicio de Medicina Intensiva, Hospital Universitario de Jerez, Departamento de Medicina, INiBICA, Facultad de Medicina de Cádiz, Cádiz, Spain, and colleagues, evaluated whether early exposure to L-AmB affected renal function in mechanically ventilated patients with SARS-CoV-2 pneumonia.
Clinicians use L-AmB in critically ill patients because of its broad antifungal activity, and they may administer it empirically when invasive fungal infection is suspected. However, concerns regarding amphotericin-associated nephrotoxicity can be particularly relevant among critically ill patients, who may already have multiple factors predisposing them to renal dysfunction.
The investigators conducted a retrospective, single-centre cohort study involving 160 patients admitted to the intensive care unit (ICU) with COVID-19 pneumonia. All patients required mechanical ventilation. Among them, 102 patients received empiric L-AmB at a dose of 3 mg/kg/day for three days, while the remaining patients did not receive antifungal therapy.
Renal outcomes were assessed at three time points: ICU admission, the third day of ICU treatment, and hospital discharge. The researchers examined serum creatinine concentrations and oliguria, while AKI was classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression was subsequently used to identify factors associated with AKI.
The analysis showed:
- Serum creatinine levels did not differ significantly between the L-AmB and non-antifungal groups at ICU admission or on day 3.
- By hospital discharge, AKI was reported in 31.6% of patients receiving L-AmB compared with 56.9% of those who did not receive antifungal treatment.
- After adjustment for potential factors, empiric L-AmB treatment was not associated with an increased risk of AKI (OR 0.18).
- Diabetes was identified as a risk factor for AKI.
- Higher serum creatinine levels on ICU day 3 were also associated with an increased likelihood of developing AKI.
The findings suggest that short-course empiric L-AmB treatment may not contribute to additional renal injury in mechanically ventilated patients with severe COVID-19 pneumonia, despite the recognised nephrotoxicity concerns surrounding amphotericin B.
However, the study's retrospective, single-centre design limits the ability to establish a causal relationship between L-AmB exposure and renal outcomes. The results should therefore be interpreted cautiously and confirmed through larger prospective studies involving critically ill populations.
Reference:
Estella, Á., Lagares, C. & Núñez, M.R. Renal safety of liposomal amphotericin B in critically Ill mechanically ventilated patients with SARS-CoV-2 pneumonia: a retrospective cohort study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-05269-2
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