Elimination of fluconazole during continuous renal replacement therapy. An in vitro assessment

Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans...

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Published in:International journal of artificial organs 2021-07, Vol.44 (7), p.453-464
Main Authors: Baud, Frédéric J, Jullien, Vincent, Abarou, Tarik, Pilmis, Benoît, Raphalen, Jean-Herlé, Houzé, Pascal, Carli, Pierre, Lamhaut, Lionel
Format: Article
Language:English
Subjects:
Adsorption
Dilution
Filters
Filtration
Fluconazole
Human health and pathology
Life Sciences
Mimicry
Polyacrylonitrile
Polysulfone
Polysulfone resins
Renal replacement therapy
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Summary:Introduction: Continuous renal replacement therapy (CRRT) efficiently eliminates fluconazole. However, the routes of elimination were not clarified. Adsorption of fluconazole by filters is a pending question. We studied the elimination of fluconazole in a model mimicking a session of CRRT in humans using the NeckEpur® model. Two filters were studied. Methods: The AV1000®-polysulfone filter with the Multifiltrate Pro. Fresenius and the ST150®-polyacrylonitrile filter with the Prismaflex. Baxter-Gambro were studied. Continuous filtration used a flowrate of 2.5 L/h in post-dilution only. Session were made in duplicate. Routes of elimination were assessed using the NeckEpur® model. Results: The mean measured initial fluconazole concentration (mean ± SD) for the four sessions in the central compartment (CC) was 14.9 ± 0.2 mg/L. The amount eliminated from the CC at the end of 6 h-session at a 2.5 L/h filtration flowrate for the AV1000®-polysulfone and the ST150®-polyacrylonitrile filters were 90%–93% and 96%–94%, respectively; the clearances from the central compartment (CC) were 2.5–2.6 and 2.4–2.3 L/h, respectively. The means of the instantaneous sieving coefficient were 0.94%–0.91% and 0.99%–0.91%, respectively. The percentages of the amount eliminated from the CC by filtration/adsorption were 100/0%–95/5% and 100/0%–100/0%, respectively. Conclusion: Neither the ST150®-polyacrylonitrile nor the AV1000®-polysulfone filters result in any significant adsorption of fluconazole.
ISSN:0391-3988
1724-6040
DOI:10.1177/0391398820976144