888. Renal Effects of Intravenous Voriconazole (V) vs. Fluconazole (F) and Caspofungin (C) in Patients with Compromised Renal Function
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Inclusion of the solubilizing excipient, sulfobutylether-b-cyclodextrin (SBECD), led to the recommendation that V be used with caution in patients with estimated creatinine clearances (CrCl; Cockcroft Gault equation) < 50 mL/min. Methods: We retrospectively evaluated renal effects of V containing SBECD compared with antifungals (AF) that do not contain SBECD (F and C) in patients with CrCl < 50 mL/min hospitalized between 1/1/2007 and 12/31/2010. Changes in serial serum creatinine (SCR) levels and CrCl were evaluated during IV AF therapy. The lowest CrCl while on therapy and at end of therapy (EOT) among the groups were compared with baseline CrCl by F-test. Results: The groups had similar characteristics apart from the larger proportion of females that received F vs. C or V (Table 1). Baseline SCR was higher in those receiving C, but maximum SCR increase and CrCl decrease were larger in F (Table 2). Renal dysfunction (RIFLE criteria) was more frequent for the F group than the C group (p<0.01); incidence of renal dysfunction in the V group was not significantly different from that of the C (p=0.56) or F (p=0.11) groups. Conclusion: SBECD inclusion in V was not associated with greater renal dysfunction in patients with CrCl < 50 mL/min than that observed with AF preparations that do not include SBECD.

Table 1: Patient demographics.

Parameter

C

V

F

p-value for overall difference

n (%)

55 (43.0)

19 (14.8)

54 (42.2)

Age, Mean (SD)

63.9 (13.9)

61.7 (13.9)

63.7 (14.7)

0.83

Male, n (%)

34 (61.8)

10 (52.6)

20 (37.0)

0.03

White, n (%)

43 (78.2)

17 (89.5)

49 (90.7)

0.63

Length of Treatment days, Mean (SD)

8.6 (5.3)

8.1 (6.3)

9.8 (9.8)

0.62

Table 2: Mean ( SD) changes in renal function by treatment group.

Parameter

C

V

F

p-value for overall difference

Baseline SCR (mg/dL)

2.8 (1.5)

2.1 (0.9)

2.2 (1.3)

0.04

Maximum SCR (mg/dL)

0.76 (1.6)

0.64 (0.7)

2.3 (2.4)

<0.01

Baseline CrCl (mL/min)

28.2 (12.0)

33.9 (9.0)

30.4 (10.3)

0.14

Lowest CrCl during therapy (mL/min)

23.3 (11.4)

27.0 (9.5)

19.1 (8.6)

0.01

CrCl at EOT (mL/min)

51.6 (38.1)

43.1 (26.5)

39.6 (22.7)

0.13

% Change CrCl - Lowest/Baseline

-17.9 (16.7)

-21.2 (13.0)

-36.4 (19.4)

<0.01

% Change CrCl - EOT/Baseline

99.1 (167.8)

27.7 (69.4)

39.2 (96.3)

0.03

Renal dysfunction, n (%)

15 (27.3)

7 (36.8)

32 (59.3)

<0.01

 


Subject Category: M. Mycology including clinical and basic studies of fungal infections

David Luke, PharmD1, Verna L. Welch, PhD, MPH2, Thomas Mayer, PhD3, Joanne Meisner, MPH3 and Craig Lilly, MD4, (1)DRL Consultants, Ledyard, CT, (2)US Medical Affairs, Pfizer, Inc, New York, NY, (3)Conquering Diseases Biorepository laboratory, University of Massachusetts Medical School, Worcester, MA, (4)Critical Care Medicine, University of Massachusetts Medical School, Worcester, MA

Disclosures:

D. Luke, Pfizer Inc: Consultant and Employee, Salary

V. L. Welch, Pfizer, Inc.: Employee and Shareholder, Salary and Stock

T. Mayer, Pfizer: Grant Investigator, Grant recipient

J. Meisner, Pfizer: Grant Investigator, Grant recipient

C. Lilly, None

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