Caspofungin pharmacokinetics in a child undergoing continuous veno-venous haemodiafiltration: a case report.

We report the case of a 13-year-old with systemic lupus erythematosus who received caspofungin for disseminated invasive aspergillosis and underwent continuous renal replacement therapy (CRRT) for acute kidney failure and fluid overload. The RRT membrane was made with polyacrylonitrile. During two days, blood samples were collected before and after the filter and from the effluent line to measure caspofungin concentrations and estimate total and CRRT (CLRRT) clearances. We found a total clearance of 13 mL/min and a mean (range) CLRRT of 10.1 (5.9-14.9) mL/min. Compared to previous studies, these findings confirm variability in CLRRT with a potential contribution of circuit adsorption. Further clinical and in vitro studies are needed to better characterize caspofungin pharmacokinetics during CRRT and identify situations in which dose adjustment may be required.