Treatment with echinocandins during continuous renal replacement therapy

Crit Care. 2014 Mar 28;18(2):218. doi: 10.1186/cc13803.

Abstract

Echinocandins are indicated as first-line treatment for invasive candidiasis in moderate to severe illness. As sepsis is the main cause of acute kidney injury, the combination of echinocandin treatment and continuous renal replacement therapy (CRRT) is common. Optimizing antibiotic dosage in critically ill patients receiving CRRT is challenging. The pharmacokinetics of echinocandins have been studied under various clinical conditions; however, data for CRRT patients are scarce. Classically, drugs like echinocandins with high protein binding and predominantly non-renal elimination are not removed by CRRT, indicating that no dosage adjustment is required. However, recent studies report different proportions of echinocandins lost by filter adsorption. Nevertheless, the clinical significance of these findings remains unclear.

Publication types

  • Review

MeSH terms

  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / therapy
  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / pharmacokinetics
  • Candidiasis, Invasive / diagnosis
  • Candidiasis, Invasive / epidemiology
  • Candidiasis, Invasive / therapy
  • Combined Modality Therapy / methods
  • Critical Illness / epidemiology
  • Critical Illness / therapy*
  • Echinocandins / administration & dosage*
  • Echinocandins / pharmacokinetics
  • Humans
  • Renal Replacement Therapy / methods*
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Echinocandins