Treatment with echinocandins during continuous renal replacement therapy
Critical Care (London, England)
|July 17, 2014
Summary
Echinocandin dosing for invasive candidiasis in patients on continuous renal replacement therapy (CRRT) is complex. While traditionally not requiring adjustment, filter adsorption may impact drug levels, though clinical significance is uncertain.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Echinocandins are first-line for invasive candidiasis.
- Sepsis-induced acute kidney injury often necessitates continuous renal replacement therapy (CRRT).
- Combining echinocandins with CRRT presents dosing challenges in critically ill patients.
Purpose of the Study:
- To review the pharmacokinetics of echinocandins in patients undergoing CRRT.
- To evaluate the impact of CRRT on echinocandin drug levels.
- To clarify the clinical significance of echinocandin removal during CRRT.
Main Methods:
- Literature review of pharmacokinetic studies.
- Analysis of data on echinocandin use in CRRT patients.
- Assessment of drug removal by CRRT filters.
Main Results:
- Limited pharmacokinetic data exists for echinocandins in CRRT patients.
- Echinocandins are typically highly protein-bound with non-renal elimination.
- Recent studies suggest potential echinocandin loss via filter adsorption, but clinical impact is unclear.
Conclusions:
- Optimizing echinocandin dosage in CRRT patients requires further investigation.
- The clinical relevance of filter adsorption for echinocandins needs clarification.
- More research is needed to guide echinocandin dosing in critically ill patients with renal replacement therapy.
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