Nephrotoxicity Risk Assessment of Liposomal Amphotericin B in Hematology–Oncology Patients: A Real-World Study From Saudi Arabia

Background: Despite nephrotoxicity concerns, liposomal amphotericin B (L-AMB) remains essential for treating invasive fungal infections in immunocompromised patients. Therefore, this study aimed to evaluate the incidence of L-AMB-associated nephrotoxicity, assess the effectiveness of nephroprotective premedication, determine treatment efficacy, and identify risk factors for adverse outcomes. Methods: A retrospective analysis was conducted on adult hematology–oncology patients who received intravenous L-AMB for ≥7 days between January 2017 and December 2020. Patients with pre-existing dialysis dependency or acute kidney injury were excluded. The primary endpoint was the incidence of acute kidney injury within two weeks of L-AMB administration. Secondary endpoints included treatment efficacy, biomarker associations, predictors of nephrotoxicity, and the effectiveness of nephroprotective strategies. Results: Among the 90 analyzed patients, 46.7% (42/90) developed nephrotoxicity within two weeks of L-AMB treatment, whereas 53.3% (48/90) did not experience nephrotoxicity. Treatment efficacy was high, with 83.3% of patients avoiding breakthrough fungal infections. Median serum creatinine levels were significantly higher in the nephrotoxicity group both before and after treatment (p < 0.001). Logistic regression identified advancing age as significantly associated with higher odds of nephrotoxicity (odds ratio (OR) = 1.032; p = 0.017). Concomitant use of colistin (OR = 10.10; p = 0.008) and cyclosporine (OR = 9.01; p = 0.027) significantly increased nephrotoxicity risk. No significant association was found between the galactomannan/β-D-glucan results and breakthrough infections (p = 0.131) or between nephroprotective premedication protocols and nephrotoxicity prevention (p = 0.798). Conclusions: L-AMB-associated nephrotoxicity affected 46.7% of the included hematology–oncology patients while maintaining acceptable antifungal efficacy (83.3% without breakthrough infections). Advancing age, colistin, and cyclosporine were identified as independent risk factors with additive nephrotoxic mechanisms. The absence of demonstrable benefits from premedication strategies likely reflects methodological limitations. These findings support enhanced renal monitoring for patients receiving concurrent nephrotoxic agents and highlight the need for prospective studies to optimize nephroprotective strategies.