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In Vitro Evaluation of Liposomal Amphotericin B Adsorption With Different Hemofilters for Continuous Hemofiltration
Toshihisa Hiraiwa1,2, Naohide Kuriyama1, Kazuhiro Moriyama1
1Department of Anesthesiology and Clinical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
Different blood purification membranes can be used to treat CHF without affecting the administration of antifungal drugs.
Insights
Continuous hemofiltration (CHF) with polysulfone (PS) membranes may temporarily adsorb liposomal amphotericin B. However, this adsorption does not significantly impact antifungal drug doses in clinical settings, allowing safe use of various hemofiltration membranes.
Area of Science:
- Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Fungemia presents a significant clinical challenge with a poor prognosis.
- Continuous hemofiltration (CHF) is crucial for managing acute kidney injury in fungemia patients.
- The interaction between hemofiltration membranes and antifungal drugs, specifically liposomal amphotericin B, requires clarification.
Purpose of the Study:
- To investigate the adsorption characteristics of liposomal amphotericin B onto different hemofiltration membranes.
- To determine the impact of hemofiltration membranes on antifungal drug concentrations during CHF.
Main Methods:
- Hemofiltration experiments were conducted using a closed-circulation system with polyacrylonitrile (AN69ST), polymethyl methacrylate (PMMA), and polysulfone (PS) membranes.
- Liposomal amphotericin B concentrations were measured at the inlet and effluent of the hemofiltration circuit.
- Adsorption rates (Ra) were calculated to quantify drug retention by the membranes.
Main Results:
- Polysulfone (PS) membranes showed a significant decrease in amphotericin B concentration after 15 minutes, indicating adsorption (p=0.03).
- The adsorption rate (Ra) of amphotericin B was significantly higher with PS membranes compared to controls (p=0.02).
- No significant adsorption of amphotericin B was observed with PMMA or AN69ST membranes, with concentrations remaining stable over 1440 minutes.
Conclusions:
- Polysulfone (PS) membranes exhibit temporary adsorption of liposomal amphotericin B.
- Despite temporary adsorption, clinical doses of liposomal amphotericin B are unlikely to be affected by PS membranes.
- Various hemofiltration membranes can be safely employed in CHF without compromising antifungal drug efficacy.
