In Vitro Evaluation of Liposomal Amphotericin B Adsorption With Different Hemofilters for Continuous Hemofiltration

Fungemia is an infectious disease with a poor prognosis. Continuous hemofiltration (CHF) is widely used for the treatment of acute kidney injury associated with fungemia. However, the effect of hemofiltration membranes for CHF on antifungal drug concentrations remains poorly understood. Therefore, clarifying the adsorption of antifungal drugs onto these membranes is important. We investigated the adsorption properties of liposomal amphotericin B on different hemofiltration membranes using closed-circulation hemofiltration.

We performed hemofiltration with each solution adjusted to liposomal amphotericin B as a closed circulatory circuit using polyacrylonitrile (AN69ST), polymethyl methacrylate (PMMA), and polysulfone (PS) membranes. Only this circuit was used as a control. Amphotericin B concentration at the inlet and in the effluent of the hemofiltration membrane was measured. The adsorption rate (Ra) of amphotericin B was then calculated.

The concentration of amphotericin B decreased in the PS membranes compared to that in the controls after 15 min (p = 0.03). The Ra of amphotericin B was higher in PS membranes than in the controls (p = 0.02). Amphotericin B was not adsorbed onto the PMMA or AN69ST membranes. The concentration of amphotericin B in these membranes showed no change compared with that in the control after 1440 min. Liposomal amphotericin B was temporarily absorbed on PS membranes, but at clinical doses, it did not appear to affect the antifungal doses.

Different blood purification membranes can be used to treat CHF without affecting the administration of antifungal drugs.