Impact of Continuous Renal Replacement Therapy with Polyacrylonitrile-Derived Filter on Caspofungin Concentration: A Retrospective Study.

INTRODUCTION

Caspofungin pharmacokinetics may be altered in critically ill patients. In vitro studies suggest significant drug adsorption with polyacrylonitrile (PAN) membranes during continuous renal replacement therapy (CRRT).

METHODS

This study retrospectively analyzed 66 plasma caspofungin concentrations (pCASconc) from 35 ICU patients between 2021 and 2024, comparing those on PAN-CRRT (n = 19) versus those without (n = 47).

RESULTS

Caspofungin is mainly prescribed for candidemia (40%) and invasive Candida infections (25.7%). Median pCASconc at 12 h was similar between groups, but at 18 and 24 h, it was significantly higher in the PAN-CRRT group [5.3 (4.1-6.9) vs. 3.3 (1.9-3.7) mg/L, p = 0.04 and 5.3 (3.9-5.8) vs. 3.1 (2.5-4.5) mg/L, p = 0.01, respectively]. ECMO use was more frequent in PAN-CRRT patients (75% vs. 21.7%, p = 0.01). Persistent candidemia occurred in three patients (one in PAN-CRRT, two in non-PAN-CRRT).

CONCLUSION

This study found no evidence of caspofungin depletion with PAN-CRRT, warranting further research on clinical outcomes.