ORAL REHYDRATION SOLUTION TO PREVENT NEPHROTOXICITY OF AMPHOTERICIN B

JUAN ECHEVARRIA Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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CARLOS SEAS Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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MARIA CRUZ Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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ELAINE CHÁVEZ Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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MIGUEL CAMPOS Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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JAVIER CIEZA Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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EDUARDO GOTUZZO Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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ALEJANDRO LLANOS Departamento de Enfermedades Infecciosas, Tropicales y Dermatológicas. Hospital Nacional Cayetano Heredia, Lima, Perú; Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú; Departamento de Medicina del Hospital Nacional Sur Este, Essalud Cuzco, Perú; Centro Médico Asistencial Casa Hogar del Campesino “Hermana Josefina Serrano”, ABC, PRODEIN, Cuzco, Perú; Departamento de Informática y Estadística. Universidad Peruana Cayetano Heredia, Lima, Perú; Servicio de Nefrología. Departamento de Medicina, Hospital Nacional Cayetano Heredia. Lima, Perú; Departamento de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Perú.

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Treatment with amphotericin B deoxycholate (AB) is associated with dose-related nephrotoxicity. We conducted an open and randomized trial to evaluate the efficacy of an oral rehydration solution (ORS) to prevent nephrotoxicity of AB, compared with an intravenous saline solution (SS). Adult patients with mucosal leishmaniasis in whom AB was indicated received either three liters or ORS or one liter of SS. Renal function tests were performed at baseline and during treatment. Forty-eight patients were included (ORS = 25, SS = 23). No difference was observed in serum creatinine, creatinine clearance, serum urea, and serum sodium values during treatment, but serum potassium values were lower in the SS group than in the ORS group (P < 0.03). Treatment was more temporarily discontinued in the SS group than in the ORS group (7 patients versus 1 patient, P = 0.02). We conclude that ORS is comparable to SS in preventing glomerular damage of AB, but more effective in preventing hypokalemia.

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