Incidence of acute kidney injury in dogs with systemic mycotic infections treated with amphotericin B (1996‐2020)

BACKGROUND: Amphotericin‐B (AmB) is an essential medication for the treatment of life‐threatening systemic mycoses but the incidence and risk factors for acute kidney injury (AKI) after its administration are not known in dogs. OBJECTIVE: Determine the incidence of and risk factors for AKI in dogs receiving AmB. ANIMALS: Fifty‐one client owned dogs receiving AmB for the treatment of systemic mycoses. METHODS: Retrospective study. Signalment, potential risk factors, AKI development (creatinine ≥0.3 mg/dL from baseline), drug formulation (deoxycholate [AmB‐D] or lipid complex [ABLC]), dose, and treatment duration were recorded. The probability of an AKI diagnosis was evaluated using a log‐rank test. The incidence of AKI and odds ratios were calculated for potential risk factors. RESULTS: Incidence of AKI was 5/12 (42%) for dogs receiving AmB‐D and 14/39 (36%) for dogs receiving ABLC. Of the 19 dogs that developed AKI, 16 (84%) continued treatment after a pause in the planned dosing protocol. Fifty percent of dogs received a cumulative dose of 6.9 mg/kg for AmB‐D and 22.5 mg/kg for ABLC (P < .01) at time of AKI diagnosis. ICU hospitalization (odds ratio [OR] 0.21, 95% confidence interval [CI]: 0.58‐0.87) and inpatient status (OR 0.25, 95% CI: 0.07‐0.86) were associated with decreased odds of AKI. CONCLUSIONS AND CLINICAL IMPORTANCE: Incidence of AKI with AmB is common but does not always preclude continued treatment. The incidence of AKI is similar between AmB‐D and ABLC, but dogs receiving ABLC tolerated a higher cumulative total dose before AKI diagnosis.