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. 2025 Aug;14(8):1997-2006.
doi: 10.1007/s40121-025-01191-6. Epub 2025 Jul 5.

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

Romain Arrestier  1   2 , Claire Pressiat  3   4 , Laura Bouabdallah  5   6 , Paul Masi  5   7 , Nicolas Mongardon  8   4 , Anne Hulin  3   4 , Armand Mekontso Dessap  5   7 , Keyvan Razazi  5   7
Affiliations

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

Romain Arrestier et al. Infect Dis Ther. 2025 Aug.

Abstract

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.

Keywords: Caspofungin; Continuous renal replacement therapy; Echinocandin; Pharmacokinetic; Therapeutic drug monitoring.

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Conflict of interest statement

Declarations. Conflict of Interest: Romain Arrestier reports personal fees from Pharma Dom, MSD and Baxter outside the submitted work. Armand Mekontso Dessap reports grants from Fisher&Paykel, Baxter, Philips, Ferring and GSK, personal fees from Air Liquide, Baxter, Amomed, Getinge and Addmedica, outside the submitted work. Keyvan Razazi received lecture fees from MSD, Shionogi, and a travel grant from Pfizer outside the submitted work. Nicolas Mongardon received personal fees from AOP Health and Baxter, and research grants from Air Liquide outside the submitted work. Ethical Approval: The French Intensive Care Society Ethics Committee approved the study (CE SRLF n° 24–093, IRB n° 00014135), and written informed consent was waived per French regulations. The study was performed in accordance with the Helsinki Declarations and all its amendments.

Figures

Fig. 1
Fig. 1
pCASconc at H12, H18, and H24 according to CRRT status. CRRT continuous renal replacement therapy, pCASconcplasma caspofungin concentration, H12, H18, and H24 number of hours between last infusion and measurement. *p < 0.05; ns = p > 0.05
Fig. 2
Fig. 2
Correlation between days of caspofungin treatment and plasma caspofungin concentrations (pCASconc) at H12, H18, and H24 in patients with and without PAN-CRRT. Scatter plots show the relationship between the duration of caspofungin treatment (in days) and plasma caspofungin concentrations (pCASconc, in mg/L) at different sampling time points. a, c, and e correspond to patients without PAN-CRRT at H12, H18, and H24, respectively; b, d, and f correspond to patients with PAN-CRRT at the same time points. Each figure part includes a linear trend line and reports the Spearman correlation coefficient (r) along with the two-tailed p value
See this image and copyright information in PMC

References

    1. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases Society of America. Clin Infect Dis. 2016;62:e1-50. - PMC - PubMed
    1. Stone JA, Xu X, Winchell GA, Deutsch PJ, Pearson PG, Migoya EM, et al. Disposition of caspofungin: role of distribution in determining pharmacokinetics in plasma. Antimicrob Agents Chemother. 2004;48:815–23. - PMC - PubMed
    1. van der Elst KCM, Veringa A, Zijlstra JG, Beishuizen A, Klont R, Brummelhuis-Visser P, et al. Low caspofungin exposure in patients in intensive care units. Antimicrob Agents Chemother. 2017. 10.1128/aac.01582-16. - PMC - PubMed
    1. Nguyen TH, Hoppe-Tichy T, Geiss HK, Rastall AC, Swoboda S, Schmidt J, et al. Factors influencing caspofungin plasma concentrations in patients of a surgical intensive care unit. J Antimicrob Chemother. 2007;60:100–6. - PubMed
    1. Bailly S, Gautier-Veyret E, Lê MP, Bouadma L, Andremont O, Neuville M, et al. Impact of loading dose of caspofungin in pharmacokinetic-pharmacodynamic target attainment for severe candidiasis infections in patients in intensive care units: the CASPOLOAD study. Antimicrob Agents Chemother. 2020;64:e01545-e1620. - PMC - PubMed

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