Table 2.

Antifungal dose adaptations during CRRT

Antifungal agent	Mechanism of action	Route of administration	Adverse effect	Elimination by CRRT	Recommended dose during CRRT
Lipid formulation of amphotericin B	Interacts with ergosterol in the fungal cell membrane	IV	Hepatic, renal and cardiovascular toxicity	Unaffected by CRRT	5 mg/kg/d
Fluconazole	Interacts with 14-demethylase in the fungal cell membrane	IV or oral	Hepatic toxicity	High elimination by CRRT	600 mg/12 h
Voriconazole	Reduces ergosterol synthesis	IV or oral	AKI toxicity with IV use, hepatic toxicity	Poor elimination of IV form by CRRT— No adaptations for CRRT	Loading dose: 6 mg/kg/12 h Maintenance dose: 4 mg/kg/12 h
Anidulafungin	Inhibits (1,3)-β-D-glucan synthetase	IV	Hepatic toxicity	Significant adsorption by CRRT adsorptive membranes	Loading dose: 200 mg/d Maintenance dose: 150 mg/d
Caspofungin	Interacts with 14-lanosterol demethylase in the fungal cell membrane and reduces ergosterol synthesis	IV	Severe hepatic toxicity	Unaffected by CRRT	Loading dose: 70 mg/d When BMI is >40 higher doses can be used (up to 140 mg/d) Maintenance dose: 50 mg/d (if >80 kg, maintenance with 70 mg/d is recommended)

AKI, acute kidney injury; CRRT, continuous renal replacement therapy; d, day; IV, intravenous.