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Contributions to nephrology最新文献

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Expanded Hemodialysis: Mechanisms and Equipment. 扩大血液透析：机制和设备。
4区 医学
Contributions to nephrology Pub Date : 2026-01-01 Epub Date: 2026-09-10 DOI: 10.1159/000552925
Angelito A Bernardo, Bernd Krause, Markus Storr, Claudio Ronco
{"title":"Expanded Hemodialysis: Mechanisms and Equipment.","authors":"Angelito A Bernardo, Bernd Krause, Markus Storr, Claudio Ronco","doi":"10.1159/000552925","DOIUrl":"https://doi.org/10.1159/000552925","url":null,"abstract":"<p><p>Clinical outcomes in hemodialysis remain suboptimal, and it is imperative to make any effort to improve the quality of life of dialysis patients. Unsatisfactory results have been correlated with the accumulation of uremic retention products in the middle- to high-molecular-weight range inadequately removed by current dialytic techniques. These toxins cause and worsen inflammation, immune dysfunction, and various pathological effects. This results in high morbidity and mortality with unacceptable rates of cardiovascular events, accelerated atherosclerosis, infection, and multiple organ dysfunction. Expanded hemodialysis (HDx) with a modern medium cut-off (MCO) membrane, which closely mimics the native kidney, significantly improves removal of such uremic toxins. Current evidence has shown that the safety, simplicity, superior performance, and efficacy of HDx with the MCO membrane translate to improved clinical outcomes.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"201 ","pages":"94-104"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemoadsorption/Hemodialysis: Current Evidence and Outcome on Uremic Toxin Removal and Symptom Improvement. 血液吸附/血液透析：尿毒症毒素去除和症状改善的最新证据和结果。
4区 医学
Contributions to nephrology Pub Date : 2026-01-01 Epub Date: 2026-09-10 DOI: 10.1159/000552913
Mario Cozzolino, Lorenza Magagnoli, Paola Ciceri
{"title":"Hemoadsorption/Hemodialysis: Current Evidence and Outcome on Uremic Toxin Removal and Symptom Improvement.","authors":"Mario Cozzolino, Lorenza Magagnoli, Paola Ciceri","doi":"10.1159/000552913","DOIUrl":"https://doi.org/10.1159/000552913","url":null,"abstract":"<p><p>Patients on maintenance hemodialysis (MHD) still have a high burden of symptoms, even with current dialysis techniques. One main reason is that many uremic toxins are not fully removed. This is especially true for protein-bound uremic toxins (PBUTs) and inflammatory factors, which are insufficient to clear with diffusion or convection modality alone. Hemoadsorption combined with hemodialysis (HAHD) allows for the removal of a wider range of toxins, including middle to large molecules and PBUTs that are hard to pass the dialysis membrane. Moreover, HAHD can match different toxin properties and thereby improve overall clearance. Current studies show that HAHD can specifically increase the removal of PBUTs and inflammatory mediators. It may also reduce microinflammation in MHD patients. Some clinical evidence supports that HAHD can improve common symptoms in MHD patients, such as chronic kidney disease-associated pruritus, sleep disorders, and restless legs syndrome. In summary, HAHD is a reasonable blood purification modality to add on standard dialysis therapy and shows potential clinical benefits. When assessing the efficacy of HAHD, attention should be paid not only to changes in clinical factors but also to subjective experiences of patients. More studies are needed to define which patients benefit most and to confirm its effects on important outcomes such as hospitalization and survival. There is also a need for more high-quality clinical evidence to support the practice of HAHD and to achieve consensus on treatment standards and protocols.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"201 ","pages":"137-147"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prelims. 预备考试。
4区 医学
Contributions to nephrology Pub Date : 2026-01-01 Epub Date: 2026-09-10 DOI: 10.1159/000553167
{"title":"Prelims.","authors":"","doi":"10.1159/000553167","DOIUrl":"https://doi.org/10.1159/000553167","url":null,"abstract":"","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"201 ","pages":"I-VI"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148929151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oxiris Membrane in Sepsis and Multiple Organ Failure. 脓毒症和多器官功能衰竭中的Oxiris膜。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527355
Matteo Cecchi, Arnau Ulsamer, Gianluca Villa
{"title":"Oxiris Membrane in Sepsis and Multiple Organ Failure.","authors":"Matteo Cecchi,&nbsp;Arnau Ulsamer,&nbsp;Gianluca Villa","doi":"10.1159/000527355","DOIUrl":"10.1159/000527355","url":null,"abstract":"<p><p>Sepsis and multiple organ failure (MOF) are characterized by multiple hemodynamic changes and imbalanced immune response of the patient. Oxiris is a highly adsorptive membrane with the ability to remove cytokines and endotoxins, as well as to perform renal replacement therapy. Here we describe the evolution from previous AN69 to the 3-in-1 Oxiris membrane, and review its characteristics and performance. In clinical practice, Oxiris showed consistent effects in mean arterial pressure recovery, a decrease in vasopressor needs, and reduction of the Sequential Organ Failure Assessment score. These results have been reproduced by several independent studies addressing both sepsis and, to a lesser extent, COVID-19 patients. In addition, more recent studies in sepsis showed improvements in MOF duration and the length of stay in the ICU, as well as some promising results regarding mortality. Finally, we review ongoing clinical trials and discuss its potential significance to clinical practice improvement and to further reinforce knowledge on the use of blood purification in sepsis and acute kidney injury.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"55-65"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemadsorption in Critically Ill Children. 危重儿童的血液吸收。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529904
Pier Paolo Duchini, Gabriella Bottari, Akash Deep, Zaccaria Ricci
{"title":"Hemadsorption in Critically Ill Children.","authors":"Pier Paolo Duchini,&nbsp;Gabriella Bottari,&nbsp;Akash Deep,&nbsp;Zaccaria Ricci","doi":"10.1159/000529904","DOIUrl":"10.1159/000529904","url":null,"abstract":"<p><p>Application of extracorporeal blood purification in children is increasing with the improvement of technology and the broadening of indications in critically ill patients. Furthermore, novel devices are being made available with a miniaturized design to be applicable to pediatric machines and circuits. Current literature in the pediatric setting is essentially based on case series and observational studies. Novel prospective uncontrolled databases are underway, and the interest is growing in children, since the potential indications for pediatric sepsis and other inflammatory conditions might rely on the enhanced mediator clearance warranted by these techniques. This review will describe the application of hemadsorption in children, the available cartridges, the clinical results available in the pediatric setting, and the potential future uses.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"242-251"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9956716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hemoperfusion in Poisoning and Drug Overdose. 中毒和药物过量时的血液灌注。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-13 DOI: 10.1159/000526730
Fiorenza Ferrari, Miriam Manera, Luigi D'Auria, Silvia De Rosa, Claudio Ronco
{"title":"Hemoperfusion in Poisoning and Drug Overdose.","authors":"Fiorenza Ferrari,&nbsp;Miriam Manera,&nbsp;Luigi D'Auria,&nbsp;Silvia De Rosa,&nbsp;Claudio Ronco","doi":"10.1159/000526730","DOIUrl":"10.1159/000526730","url":null,"abstract":"<p><p>Hemoperfusion (HP) is an extracorporeal blood purification therapy that is used to remove poisons or drugs from the body. This chapter provides a brief overview of the technical aspects and the potential indications and limitations of HP, with the focus being on the use of HP for acute poisoning cases reported from January 1, 2000, to April 30, 2022.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"218-241"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9957579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined Hemoperfusion-Hemodialysis in End-Stage Renal Disease Patients. 终末期肾病患者的联合血液灌注血液透析。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527953
Claudio Ronco
{"title":"Combined Hemoperfusion-Hemodialysis in End-Stage Renal Disease Patients.","authors":"Claudio Ronco","doi":"10.1159/000527953","DOIUrl":"10.1159/000527953","url":null,"abstract":"<p><p>Despite advances in dialysis technology, a high level of morbidity and mortality is still present in end-stage renal disease patients undergoing maintenance dialysis. This has been in great part correlated with accumulation of uremic toxins that cannot be adequately removed by classic dialysis membranes and techniques. Improvements have been made in enhancing both membrane permeability and convection rates as in the case for expanded hemodialysis (HD) and hemodiafiltration, but these techniques still present limitations or cannot be performed due to technical reasons. Considering the abovementioned limitations of current dialysis techniques, the additional use of adsorption as a solute removal mechanism may represent an interesting option. Recent studies have underlined the significant improvement in the levels of medium-large retention solutes and toxin-related symptoms using a combination of hemoperfusion with HD at least in a session per week. These studies need further confirmation, but they may represent the doorway to further improve patient's outcome in maintenance dialysis.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"118-122"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9959571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Process of Adsorption and Cartridge Design. 吸附过程与滤筒设计。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529295
Claudio Ronco, Rinaldo Bellomo
{"title":"The Process of Adsorption and Cartridge Design.","authors":"Claudio Ronco,&nbsp;Rinaldo Bellomo","doi":"10.1159/000529295","DOIUrl":"10.1159/000529295","url":null,"abstract":"<p><p>The mechanism of adsorption is regulated by various factors including the nature of the sorbent and the molecules involved in the adsorption process. The design of a device for adsorption therapies must fulfil specific requirements. The device should allow the use of the minimum amount of sorbent material sufficient to achieve safe and effective blood purification therapy. Each component of the device must respond to criteria of safety and function in order to maximize the efficiency of the cartridge. The design should be optimized to enable utilization of all the sorbent surface available for adsorption. The structure and packing of the sorbent particles should allow the even distribution of flow inside the cartridge and the avoidance of channeling phenomena and excessive resistance to flow. All these factors depend on specific governing laws such as the Kozeny-Carman equation and Darcy's law. The system must also consider blood viscosity and possible turbulent flows (Reynolds number). The final manufacturing process of a sorbent unit must also consider the dimensions and the cost, and the final performance after sterilization and storage.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Liver Support Techniques in Acute and Hyperacute Liver Failure. 急性和超急性肝功能衰竭的肝支持技术。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527343
Sanjay Chaudhary, Kianoush B Kashani
{"title":"Liver Support Techniques in Acute and Hyperacute Liver Failure.","authors":"Sanjay Chaudhary,&nbsp;Kianoush B Kashani","doi":"10.1159/000527343","DOIUrl":"10.1159/000527343","url":null,"abstract":"<p><p>With the growing prevalence of acute liver failure or acute-on-chronic liver failure, on the one hand, and the limited supply of liver organs for transplantation, on the other hand, it is critical to the design, validate, and implement devices that can provide extracorporeal liver support (ECLS) as the bridge to transplantation or potentially destination therapies. The number of attempts to generate ECLS devices has resulted in several options with various levels of impact on clinical outcomes. The described ECLS tools could be as simple as devices used for kidney replacement therapies (e.g., continuous kidney replacement therapy) to tools that employ albumin (e.g., Prometheus, single-pass albumin dialysis, or molecular adsorbent recirculating system), fresh frozen plasma (e.g., high-volume plasmapheresis), or hepatocytes (e.g., extracorporeal liver assist device with hepatocytes) to support failing liver functions, that is, metabolic or synthetic functions. This chapter describes the current landscape of ECLS devices and their associated evidence-based data.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"32-44"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sequential Extracorporeal Therapy in Sepsis. 脓毒症的序贯体外治疗。
4区 医学
Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-08 DOI: 10.1159/000527573
Silvia De Rosa, Salvatore Lucio Cutuli, Anna Lorenzin, Monica Zanella
{"title":"Sequential Extracorporeal Therapy in Sepsis.","authors":"Silvia De Rosa,&nbsp;Salvatore Lucio Cutuli,&nbsp;Anna Lorenzin,&nbsp;Monica Zanella","doi":"10.1159/000527573","DOIUrl":"10.1159/000527573","url":null,"abstract":"<p><p>Sepsis is a life-threatening syndrome initiated by a dysregulated host response to infection. Maladaptive inflammatory burst damages host tissues and causes organ dysfunction, the burden of which has been demonstrated as the paramount predictor of worse clinical outcomes. In this setting, septic shock represents the most lethal complication of sepsis and implies profound alterations of both the cardiovascular system and cellular metabolism with consequent high mortality rate. Although an increasing amount of evidence attempts to characterize this clinical condition, the complexity of multiple interconnections between underlying pathophysiological pathways requires further investigations. Accordingly, most therapeutic interventions remain purely supportive and should be integrated in light of the continuous organ cross-talk, in order to match a patient's specific needs. In this context, different organ supports may be combined to replace multiple organ dysfunctions through the application of sequential extracorporeal therapy in sepsis (SETS). In this chapter, we provide an overview of sepsis-induced organ dysfunction, focusing on the pathophysiological pathways that are triggered by endotoxin. Based on the need to apply specific blood purification techniques in specific time windows with different targets, we suggest a sequence of extracorporeal therapies. Accordingly, we reported the hypothesis that sepsis-induced organ dysfunction may benefit the most from SETS. Finally, we point out basic principles of this innovative approach and describe a multifunctional platform that allows SETS, in order to make clinicians aware of this new therapeutic frontier for critically ill patients.</p>","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"149-159"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9957558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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