Echinocandins and Continuous Renal Replacement Therapies: The Role of Adsorption

The following reviews [1,2], about continuous renal replacement therapies (CRRT) and echinocandins conclude that the membranes do not significantly adsorb these antifungals.

The first review [1], that evaluates several articles [3-7], concludes that the elimination of echinocandins due to adsorption to membrane surfaces is not likely to be clinically relevant, once the concentration in steady state equilibrium is reached. They point out that 20% is lost with the first dose but that it is not relevant, at least it is not important, for anidulafungin and caspofungin because these drugs are prescribed with loading dose to achieve steady state balance on the first day. On the other hand, it indicates that in the case of micafungin, its loss could be relevant due to the lack of loading dose. This drug loss could occur mainly on the first day of TCRR or after filter replacement. A new filter has a greater adsorptive capacity and even more if the filter membranes have a high adsorptive capacity and the ultrafiltrate flows are high. It is also unknown whether repeated coagulation of the filter could affect the fungicidal activity of these antifungals. Finally, there are some limitations of these studies regarding the small size of the sample and the heterogeneity of the studied population, as well as a lack of standardization and validation of the determinations to obtain the concentrations of the echinocandins, so that it requires caution in order to evaluate the results of the studies.