Prospective study of pharmacokinetics of isavuconazole in critically ill patients undergoing continuous hemodialysis with and without acute-on-chronic liver failure
Authors' conclusion
ACLF did not significantly alter isavuconazole clearance during RRT.
Study context
- Population
- Critically ill adults receiving isavuconazole and continuous renal replacement therapy (RRT), 12 ICUs, University Medical Center Hamburg-Eppendorf
- Participants
- 13 adults
- Exposure
- Acute-on-chronic liver failure (ACLF) vs non-liver failure
- ACLFn = 4
- Outcome
- Effect of ACLF and continuous RRT on isavuconazole PK, particularly clearance
Methodological detailssingle-centre, population pharmacokinetics (PK) modelling, Monte Carlo simulations
- Single-centre
- Population PK modelling
- Monte Carlo simulations
Main finding
As reported in the abstract
Isavuconazole clearance
P = 0.92
- Dialysis clearance negligible
- <1% of dose
Observational data: associations, not effects.
Further findings
Target attainment (all patients)
- 50% efficacy target (AUC0-24h/MIC = 24.7) achieved
- 12/13 patients (92%)
- 90% target (AUC0-24h/MIC = 33.4) achieved
- 8/13 patients (62%)
- Simulations: suboptimal probability of target attainment (PTA) at Aspergillus fumigatus breakpoint of 1 mg/L
- Considerable interindividual variability on clearance, particularly in ACLF, with sub- and supratherapeutic exposures
Original publication
Prospective study of pharmacokinetics of isavuconazole in critically ill patients undergoing continuous hemodialysis with and without acute-on-chronic liver failure. Ann Intensive Care. Published 14 May 2026. doi:10.
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