Pharmacokinetics of anidulafungin during albumin dialysis

In the ICU setting, current guidelines recommend echinocandins as the first-line treatment for invasive candidiasis [1]. Albumin dialysis (AD) has been used in the ICU as supportive therapy for hepatic failure, but this technique can significantly enhance drug elimination [2]. We prescribed anidulafungin for suspected invasive candidiasis in a patient with severe liver failure treated with AD and measured the plasma concentrations of the drug using high-performance liquid chromatography. This study (GEF-ANI-2010-02) was approved by the local ethics committee (INCLIVA, Institute of Research, Valencia, Spain) and written informed consent was obtained from the patient’s next of kin. An adult patient was admitted to our ICU with acute liver failure after major hepatectomy for metastasis. The patient was given anidulafungin (200 mg loading dose on day 1, followed by 100 mg daily) for suspected invasive candidiasis. On the fourth day, the patient developed encephalopathy and complained of increasing pruritus. AD using the Molecular Adsorbent Recirculating System (Gambro Hospal AG, Zurich, Switzerland) was therefore started while waiting for liver function to improve. Arterial blood, urine, and dialysate samples were collected at different times after the first AD session was initiated: before starting the fourth anidulafungin infusion and at 0.5, 1, 1.5, 2, 4, 6, and 8 hours after starting the infusion.