Effect of Voriconazole Injection for 1 Week or Longer on the Kidneys of Patients with Renal Impairment

Injection-delivered voriconazole (VRCZ), developed with sulfobutylether-β-cyclodextrin, could accumulate in the kidneys, adversely affecting their function. Therefore, VRCZ injections are generally not recommended for patients with a creatinine clearance (Ccr) < 50 mL/min. The effect of VRCZ injection for ≥1 week on the kidneys of patients with moderate-to-severe renal impairment at baseline remains unclear. Therefore, we retrospectively investigated renal function alterations and the incidence of acute kidney injury (AKI) by collecting data from 76 patients who received VRCZ injections for at least a week. Of the assessed patients, 13 displayed a Ccr < 50 mL/min at baseline (renal dysfunction group). No AKI incidence was observed in the renal dysfunction group. Among the patients with the Ccr ≥ 50 mL/min (normal renal function group), 11 out of 63 developed AKI. The normal renal function group had more patients taking at least three drugs with a potential risk of renal dysfunction than the renal dysfunction group (17 and 0 patients, respectively; P = 0.033). In conclusion, VRCZ injection might be used for ≥1 week without AKI, even in patients with renal dysfunction, especially when patients are free of potentially nephrotoxic agents. However, even patients with normal renal function could develop AKI during treatment with VRCZ injections, especially when combined with multiple drugs exhibiting the potential risk of renal impairment.