Are salt loading and prolonging infusion period effective in prevention of amphotericin B-induced nephrotoxicity?

Nephrotoxicity is generally considered as the most clinically significant adverse reaction of amphotericin B, and has been reported in up to 80% of amphotericin B recipients during the first 2 weeks of treatment. Numerous experimental and clinical investigations have been performed over the past 4 decades, to find appropriate interventions for preventing or minimizing the nephrotoxic effects of amphotericin B. The aim of this literature review was to collect available clinical data regarding interventions to prevent amphotericin B-induced nephrotoxicity in human populations. A literature search was performed in the following databases: Scopus, Medline, Embase, Cochrane central register of controlled trials, and Cochrane database systematic reviews. The key words used as search terms were 'amphotericin', 'amphotericin B', 'nephrotoxicity', 'renal failure', 'renal damage', 'renal dysfunction', 'renal impairment', 'prevention', 'preventive measures', and 'preventive interventions'. Studies in humans have clearly demonstrated that salt loading can prevent or alleviate an amphotericin B-induced rise in serum creatinine, or decrease in glomerular filtration rate, without beneficial effects on tubular toxicity of amphotericin B. Current clinical data regarding the prolongation of amphotericin B duration of infusion in the prevention of nephrotoxicity is controversial and associated with several clinical and practical drawbacks.