M-2136. Dosing of Antifungal Therapy in Dialysis Dependent Patients
Session: Poster Session: Antifungal Drugs
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Acute renal injury is a common problem in critically ill patients with invasive fungal infections (IFI). However, the prevalence of appropriate drug dosing in dialysis patients has not been studied extensively. The objective of this study was to assess the antifungal dosing received in dialysis patients with an IFI. Methods: Data on the epidemiology and treatment of IFI in dialysis dependent patients were extracted from the PATH Alliance® a prospective, multicenter, observational registry of patients with proven or probable IFI (n=451). We compared the mean daily dose (mg/kg) with current recommendations defined according to IDSA guidelines for patients with impaired renal function. Results: The data from 451 adult patients on hemodialysis (HD) (n=320), peritoneal dialysis (PD) (n=23), and continuous venous-venous hemofiltration (CVVHD) (n=108) were reviewed. A total of 502 IFIs (n=429 proven and n= 22 probable) were documented. Candidiasis was the leading type of fungal infection (87.0%). The crude mortality rate at 12 weeks post-diagnosis of IFI was 74.1% for CVVHD, 50.6% for HD and 39.1% for peritoneal dialysis patients. In non-dialysis patients, the rate was 27.7%. The average daily dose of fluconazole was 262.7 mg and 248.1 mg in patients on CVVHD and HD, respectively. In the fluconazole-treated patients, underdosing occurred in 100% of the CVVHD group; 87.5% received a dose less than 6 mg/kg. Conclusion: Many dialysis patients were observed to have received antifungal therapy at doses below published guidelines. Increased attention to published pharmacokinetics guidelines for appropriate antifungal dosing will contribute to improved outcome and potentially reduce the emergence of antifungal-resistant pathogens.
Ali Olyaei, PharmD1, D Horn2, E Anaissie3, Jay Fishman, MD, FIDSA4, K Webester5, K Marr6, L Strasfeld6, M Pfaller7, W Steinback8 and  A. J. Olyaei,
ASTELLA Role(s): Board Member, Received: Consulting Fee.
Pfizer Role(s): Speaker's Bureau, Received: Speaker Honorarium., (1)Oregon Health & Science University, Portland, OR, (2)Thomas Jefferson Univ. Hosp, (3)Univ. of AR for Med. Sciences, (4)I D Unit, Massachusetts General Hospital, Boston, MA, (5)Axiom Real-Time Metrics, Inc, (6)OHSU, (7)Univ. of IA health Care, (8)Duke Univ. Med. Ctr


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