Treatment with echinocandins during continuous renal replacement therapy

Table 1 Comparison of pharmacokinetic parameters of echinocandins in patients receiving and not receiving continuous renal replacement therapy

		Pharmacokinetic parameter
		C_max, μg/mL	AUC_0-24h, μg·hour/mL	t_1/2, hours	CL_T	V_d
PK studies in patients not receiving CRRT	Caspofungin [69]^a	12.04	96.01	9.29	0.59 L/hour	N/A
	Anidulafungin [70]^b	7.2	110.3	24-26	1.0 L/hour	34.5 L
	Micafungin [71]^c	7.1	59.9	13.0	1.25 L/hour	23.0 L
PK studies in patients receiving CRRT	Weiler et al. [42]^d
	Single doses (CVVHF)	8.4	91	11.7	7.8 mL/hour per kg	138 mL/kg
	Single doses (CVVHD)	8.2	76	12.4	9.8 mL/hour per kg	175 mL/kg
	Single doses in patients not receiving CRRT	7.3	58	9.5	10.8 mL/hour per kg	135 mL/kg
	Steady-state (CVVHF)	11.0	107	12.4	5.3 mL/hour per kg	97 mL/kg
	Steady-state (CVVHD)	10.8	141	15.2	4.2 mL/hour per kg	89 mL/kg
	Steady-state in patients not receiving CRRT	8.8	100	12.6	4.9 mL/hour per kg	104 mL/kg
	Leitner et al. [36]^e	8.5	109.9	28.8	NR	42 L
	De Rosa et al. [72]^f	5.68-9.04	67.48-98.18	15.34-31.99	1.48-2.6 L/hour	32.81-48.48 L
	Kishino et al. [73]^g	6.31	50.04	13.63	0.59 L/hour	11.53 L
	Hirata et al. [43]^h
	Patients receiving CRRT	N/A	N/A	N/A	1.4 L/hour	17.5 L
	Patients not receiving CRRT	N/A	N/A	N/A	1.4 (L/hour	16.2 L

Data are derived from different sources and trials and therefore are not always directly comparable. ^aPharmacokinetic data following single doses of 70 mg of caspofungin. ^bPharmacokinetic data following loading dose of 200 mg and maintenance dose of 100 mg of anidulafungin. ^cPharmacokinetic data following single doses of 100 mg of micafungin. ^dPharmacokinetics of caspofungin (single doses and steady-state) in critically ill patients on continuous venovenous hemofiltration (CVVHF), continuous venovenous hemodialysis (CVVHD), and control group not on continuous renal replacement therapy (CRRT). ^ePharmacokinetics of anidulafungin during CVVHF. ^fPharmacokinetics of anidulafungin in two critically ill patients with septic shock undergoing CVVHF. ^gPharmacokinetics of 50 mg of micafungin (steady-state) in living donor liver recipients receiving CVVHF. ^hPharmacokinetics of micafungin (150-300 mg) in patients on continuous venovenous hemodiafiltration and not receiving CRRT. AUC_0–24, area under the curve over 24-hour dosing interval; CL_T, total clearance (L/h or mL/hour per kg); C_max, maximum concentration; N/A, not available; NR, not reported; PK, pharmacokinetic; t_1/2, elimination half-life; V_d, volume of distribution (L or mL/kg).

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