Amphotericin B therapy in an anephric patient

Area of Science:

• Pharmacokinetics and Drug Metabolism
• Nephrology and Critical Care

Background:

• Systemic candidiasis is a serious opportunistic infection, particularly in immunocompromised patients.
• Renal transplantation failures can lead to complications like candidiasis, necessitating antifungal therapy.
• Understanding drug clearance is crucial for optimizing treatment, especially in patients with impaired renal function.

Purpose of the Study:

• To determine serum levels of amphotericin B during and after therapy in an anephric patient.
• To investigate the dialyzability of amphotericin B in vivo and in vitro.
• To assess amphotericin B's behavior with hemodialysis and high-flux membrane filtration.

Main Methods:

• Serial serum sampling for amphotericin B levels in an anephric patient undergoing treatment.
• In vivo hemodialysis study over 6 hours.
• In vitro dialysis of amphotericin B in water and filtration using a Pellicon membrane (retaining >100,000 MW).

Main Results:

• No progressive accumulation of amphotericin B was observed in serum.
• Drug clearance pattern in the anephric patient mirrored that in patients with normal renal function.
• Amphotericin B was not dialyzable with conventional hemodialysis membranes and was excluded by the Pellicon filter.

Conclusions:

• Amphotericin B pharmacokinetics are not significantly altered by the absence of renal function.
• Hemodialysis is ineffective for removing amphotericin B, irrespective of plasma protein binding.
• High-flux filtration methods also do not facilitate amphotericin B clearance.