Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B

Nicole M. Bohm, Katherine C. Hoover, Amy E. Wahlquist, Yusheng Zhu, Juan Carlos Q. Velez

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval (CI), 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

Original languageEnglish (US)
Pages (from-to)6816-6823
Number of pages8
JournalAntimicrobial agents and chemotherapy
Volume59
Issue number11
DOIs
StatePublished - Nov 1 2015

Fingerprint

Hyperphosphatemia
Case-Control Studies
Triazoles
Acute Kidney Injury
Chronic Renal Insufficiency
Phosphorus
Odds Ratio
Endpoint Determination
Confidence Intervals
liposomal amphotericin B
Inpatients
Therapeutics
Incidence
Serum

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Bohm, Nicole M. ; Hoover, Katherine C. ; Wahlquist, Amy E. ; Zhu, Yusheng ; Velez, Juan Carlos Q. / Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B. In: Antimicrobial agents and chemotherapy. 2015 ; Vol. 59, No. 11. pp. 6816-6823.
@article{fe9a78a7f8ed4a84be7238a9a3f07b1a,
title = "Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B",
abstract = "Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40{\%} [14/35 cases] versus 10{\%} [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95{\%} confidence interval (CI), 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59{\%} [10/17 cases] versus 20{\%} [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95{\%} CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.",
author = "Bohm, {Nicole M.} and Hoover, {Katherine C.} and Wahlquist, {Amy E.} and Yusheng Zhu and Velez, {Juan Carlos Q.}",
year = "2015",
month = "11",
day = "1",
doi = "10.1128/AAC.01306-15",
language = "English (US)",
volume = "59",
pages = "6816--6823",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "11",

}

Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B. / Bohm, Nicole M.; Hoover, Katherine C.; Wahlquist, Amy E.; Zhu, Yusheng; Velez, Juan Carlos Q.

In: Antimicrobial agents and chemotherapy, Vol. 59, No. 11, 01.11.2015, p. 6816-6823.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Case-control study and case series of pseudohyperphosphatemia during exposure to liposomal amphotericin B

AU - Bohm, Nicole M.

AU - Hoover, Katherine C.

AU - Wahlquist, Amy E.

AU - Zhu, Yusheng

AU - Velez, Juan Carlos Q.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval (CI), 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

AB - Pseudohyperphosphatemia due to an interaction between liposomal amphotericin B and the Beckman Coulter PHOSm assay occurs sporadically and remains underrecognized in clinical practice. This retrospective case-control study compares the incidences of hyperphosphatemia in adult inpatients exposed to liposomal amphotericin B or a triazole. A case series of patients with confirmed pseudohyperphosphatemia is described. A total of 80 exposures to liposomal amphotericin B and 726 exposures to triazoles were identified. Among subjects without chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia occurred more often during liposomal amphotericin B therapy than during triazole therapy (40% [14/35 cases] versus 10% [47/475 cases] of cases; P < 0.01; adjusted odds ratio, 5.2 [95% confidence interval (CI), 2.3 to 11.9]). Among individuals with chronic kidney disease and no concomitant acute kidney injury, hyperphosphatemia also occurred more often during liposomal amphotericin B exposure (59% [10/17 cases] versus 20% [34/172 cases] of cases; P < 0.01; adjusted odds ratio, 6.0 [95% CI, 2.0 to 18.0]). When acute kidney injury occurred during antifungal exposure, the frequencies of hyperphosphatemia were not different between treatments. Seven episodes of unexpected hyperphosphatemia during liposomal amphotericin B exposure prompted a confirmatory test using an endpoint-based assay that found lower serum phosphorus levels (median difference of 2.5 mg/dl [range, 0.6 to 3.6 mg/dl]). Liposomal amphotericin B exposure confers a higher likelihood of developing hyperphosphatemia than that with exposure to a triazole antifungal, which is likely attributable to pseudohyperphosphatemia. Elevated phosphorus levels in patients receiving liposomal amphotericin B at institutions using the Beckman Coulter PHOSm assay should be interpreted cautiously.

UR - http://www.scopus.com/inward/record.url?scp=84946215895&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84946215895&partnerID=8YFLogxK

U2 - 10.1128/AAC.01306-15

DO - 10.1128/AAC.01306-15

M3 - Article

C2 - 26282423

AN - SCOPUS:84946215895

VL - 59

SP - 6816

EP - 6823

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 11

ER -