Hiraiwa Toshihisa, Kuriyama Naohide, Moriyama Kazuhiro, Yamada Shigeki, Nakamura Tomoyuki, Nishida Osamu
Department of Anesthesiology and Clinical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan.
Department of Pharmacy, Fujita Health University Hospital, Aichi, Japan.
Artif Organs. 2025 Jul;49(7):1126-1131. doi: 10.1111/aor.14980. Epub 2025 Apr 4.
Fungemia is an infectious disease with a poor prognosis. Continuous hemofiltration (CHF) is widely used for the treatment of acute kidney injury associated with fungemia. However, the effect of hemofiltration membranes for CHF on antifungal drug concentrations remains poorly understood. Therefore, clarifying the adsorption of antifungal drugs onto these membranes is important. We investigated the adsorption properties of liposomal amphotericin B on different hemofiltration membranes using closed-circulation hemofiltration.
We performed hemofiltration with each solution adjusted to liposomal amphotericin B as a closed circulatory circuit using polyacrylonitrile (AN69ST), polymethyl methacrylate (PMMA), and polysulfone (PS) membranes. Only this circuit was used as a control. Amphotericin B concentration at the inlet and in the effluent of the hemofiltration membrane was measured. The adsorption rate (Ra) of amphotericin B was then calculated.
The concentration of amphotericin B decreased in the PS membranes compared to that in the controls after 15 min (p = 0.03). The Ra of amphotericin B was higher in PS membranes than in the controls (p = 0.02). Amphotericin B was not adsorbed onto the PMMA or AN69ST membranes. The concentration of amphotericin B in these membranes showed no change compared with that in the control after 1440 min. Liposomal amphotericin B was temporarily absorbed on PS membranes, but at clinical doses, it did not appear to affect the antifungal doses.
Different blood purification membranes can be used to treat CHF without affecting the administration of antifungal drugs.
真菌血症是一种预后较差的传染病。持续血液滤过（CHF）广泛用于治疗与真菌血症相关的急性肾损伤。然而，用于CHF的血液滤过膜对抗真菌药物浓度的影响仍知之甚少。因此，阐明抗真菌药物在这些膜上的吸附情况很重要。我们使用闭路循环血液滤过研究了脂质体两性霉素B在不同血液滤过膜上的吸附特性。
我们使用聚丙烯腈（AN69ST）、聚甲基丙烯酸甲酯（PMMA）和聚砜（PS）膜，以脂质体两性霉素B调整的每种溶液进行血液滤过，作为闭路循环。仅该循环用作对照。测量血液滤过膜入口和流出液中两性霉素B的浓度。然后计算两性霉素B的吸附率（Ra）。
15分钟后，与对照组相比，PS膜中两性霉素B的浓度降低（p = 0.03）。PS膜中两性霉素B的Ra高于对照组（p = 0.02）。两性霉素B未吸附在PMMA或AN69ST膜上。1440分钟后，这些膜中两性霉素B的浓度与对照组相比无变化。脂质体两性霉素B暂时吸附在PS膜上，但在临床剂量下，似乎不影响抗真菌剂量。
不同的血液净化膜可用于治疗CHF，而不影响抗真菌药物的给药。
