Ex vivo Rezafungin Adsorption and Clearance during Continuous Renal Replacement Therapy

Background/Aims: To determine adsorption and transmembrane clearances (CL _TM ) of rezafungin, a novel long-acting echinocandin, in continuous venovenous hemofiltration (CVVH). Methods: A validated ex vivo bovine blood CVVH model using polysulfone and AN69 hemodiafilters was used to evaluate urea and rezafungin CL _TM at 3 different ultrafiltrate flow rates. Rezafungin adsorption to the CRRT apparatus was determined for each hemodiafilter. Results: The sieving coefficient (S _C ) from CVVH with 3 different ultrafiltrate flow rates was 0 for both HF1400 and Multiflow-150 hemodiafilters, while urea S _C was approximately 1 at all flow rates. Hemodiafilter type and ultrafiltrate flow rate did not influence CL _TM . Rezafungin adsorption to the CVVH apparatus was not observed for either hemodiafilter. Conclusion: Rezafungin is not removed by CVVH by membrane adsorption or via CL _TM . Ultrafiltrate flow rates and hemodiafilter types are unlikely to influence rezafungin CL _TM . No dosage adjustment of rezafungin is likely required for critically ill patients receiving CVVH.