REFERENCE BOOK
KDIGO Clinical Practice Guideline for Acute Kidney Injury
Research Recommendations
Research recommendations
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Some studies indicate that the liposomal form of amphotericin B is less nephrotoxic than amphotericin B lipid complex or amphotericin B colloidal dispersion. RCTs in patients with systemic mycosis, with the rate of AKI as a primary or secondary end-point, should be conducted to answer this question.
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Innovative strategies to formulate amphotericin B in microvesicles, nanoparticles, or micelles should be undertaken to limit nephrotoxicity in treating fungal infections. Clinical trials should compare existing formulations to these novel formulations, and could generate cost-effective, yet non-nephrotoxic derivatives of amphotericin B.
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Carefully selected combinations of antifungal therapies to enhance efficacy and shorten duration of therapy may limit toxicity and reduce costs in the treatment of fungal infections. Investigations need to be carried out in the laboratory and in clinical studies to improve the care of patients with severe fungal infections. The costs and complication rates of AKI, and other toxicities of shortcourse combination treatment, should be compared to standard dosing regimens of antifungal therapy.
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Markers of early nephrotoxicity and mechanisms to avoid nephrotoxicity with amphotericin B formulations need to be studied further in clinical investigations. These antifungal agents are given for prolonged periods, and should allow ample opportunity to test the validity of novel biomarkers of drug-induced nephrotoxicity. A group monitored with novel AKI biomarkers should be compared to conventional monitoring of AKI, to determine if one or more early biomarkers of kidney injury add to standard clinical care in the prevention of drug-induced AKI.
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