Contributions to nephrology最新文献_第3页

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527570

Jack C Eldridge, Yize I Wan, John R Prowle

{"title":"Hemoperfusion in Trauma.","authors":"Jack C Eldridge, Yize I Wan, John R Prowle","doi":"10.1159/000527570","DOIUrl":"10.1159/000527570","url":null,"abstract":"Major trauma care has seen significant improvements in early mortality, reflecting improvements in prehospital techniques for hemorrhage control and speed of access to specialized trauma centers. However, many patients then go on to die in the intensive care unit (ICU), and improvements in immediate trauma care are presenting intensivists with greater numbers of severely injured patients who might previously have died shortly after injury. It is theorized that, despite initial survival, these patients deteriorate due to massive release of damage associated molecular patterns (DAMPs) after traumatic and ischemic tissue injury. These trigger a vicious cycle of overactive pro- and anti-inflammatory pathways, leading to organ dysfunction and immunoparesis. Extracorporeal hemoperfusion, with its ability to adsorb both DAMPs and inflammatory mediators from the bloodstream, has the potential to break this cycle and could, in theory, then prevent early death or organ dysfunction in the ICU. However, currently, there has been little research around the indications for, and efficacy of, this therapy in the setting of polytrauma. Here we outline potential molecular targets, summarize existing exploratory studies, and suggest areas for future research required to establish the benefits of hemoperfusion as an adjunct therapy in major polytrauma.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"169-179"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947982","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

Monitoring Treatment, Risks and Side Effects. 监测治疗、风险和副作用。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527344

Zsolt Molnár, Jakub Szrama, Katarzyna Sierakowska

{"title":"Monitoring Treatment, Risks and Side Effects.","authors":"Zsolt Molnár, Jakub Szrama, Katarzyna Sierakowska","doi":"10.1159/000527344","DOIUrl":"10.1159/000527344","url":null,"abstract":"Inflammation plays a key role in the pathophysiology of organ dysfunction in the critically ill patients and is triggered by an overwhelming host response resulting in the overproduction of various cytokines. Regaining immune homeostasis over the dysregulated immune response through broad removal of cytokines using extracorporeal blood purification therapies has recently gained increasing attention. Nonetheless, many questions remain regarding the appropriate monitoring treatment, its potential risks, and side effects. The CytoSorb blood purification, the most extensively investigated device, has been shown to effectively remove an array of cytokines that may lead to rapid hemodynamic stabilization as indicated by reduced vasopressor need during the treatment, as well as an improvement in vital organ function. However, reported survival benefits have been fairly inconsistent. The therapy has also been confirmed as being safe and well tolerated. Despite several questions remaining such as the right timing, duration, frequency, concomitant antibiotic use, and most appropriate patient group with the highest change of benefit, the additional use as adjuvant therapy in hyperinflammatory states and/or in patients refractory to best standard care seems reasonable. Of note, there are several randomized controlled trials currently registered and ongoing that hopefully will provide answers to some of the above questions in the not-too-distant future.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"98-106"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9947983","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

Extracorporeal Techniques Based on Adsorption: Nomenclature, Hardware, and Circuit Design. 基于吸附的体外技术：命名、硬件和电路设计。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529313

Claudio Ronco, Rinaldo Bellomo

{"title":"Extracorporeal Techniques Based on Adsorption: Nomenclature, Hardware, and Circuit Design.","authors":"Claudio Ronco, Rinaldo Bellomo","doi":"10.1159/000529313","DOIUrl":"10.1159/000529313","url":null,"abstract":"Sorbents have been utilized in the past for intoxication and poisoning, but their spectrum of clinical application is now expanding. Hemoadsorption (HA) is still indicated for toxin and poison removal, but other molecules are considered appropriate targets for this blood purification modality. HA combined with hemodialysis (HA + HD) has been proposed for end-stage kidney disease patients to remove molecules that are not easily removed by classic HD or hemodiafiltration. More recently, a rationale for the use of sorbents in critical illness, sepsis, and acute kidney injury has emerged due to the proposed humoral theory behind these disorders. Pathogenetic circulating molecules in critical illness (damage- and pathogen-associated molecular patterns) cannot be sufficiently removed by classic continuous renal replacement therapies. New sorbent-based extracorporeal therapies have therefore been designed to remove these molecules, offering potential biological and clinical benefits. There is also the possibility of employing selective sorbents to target specific molecules or to perform nonspecific HA for a wide spectrum of molecules. Moreover, there is the possibility of separating plasma from blood and then applying adsorption to plasma or of combining HA with other extracorporeal therapies. Here, we describe a complete appraisal of current available techniques utilizing adsorption.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"66-73"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9959569","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: Research Agenda and Potential Future Applications. 血液吸附：研究议程和潜在的未来应用。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-15 DOI: 10.1159/000528056

Rinaldo Bellomo, Matteo Marcello, Claudio Ronco

引用次数: 0

Hemoperfusion: Indications, Dose, Prescription. 血液灌注：适应症，剂量，处方。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529294

Frank Bidar, Stanislas Abrard, Antoine Lamblin, Thomas Rimmelé

{"title":"Hemoperfusion: Indications, Dose, Prescription.","authors":"Frank Bidar, Stanislas Abrard, Antoine Lamblin, Thomas Rimmelé","doi":"10.1159/000529294","DOIUrl":"10.1159/000529294","url":null,"abstract":"Recent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, extensive burns, and trauma or to ensure antiplatelet therapy drug removal. They can be applied as stand-alone therapies or combined with renal replacement therapy. The usual prescribed blood flow varies between 100 and 700 mL/min. CytoSorb® sessions usually last 24 h and may be repeated up to 7 days, whereas HA330/380, polymyxin B, and Seraph® sessions usually last between 2 and 4 h and are repeated up to 3 days. Current clinical data are lacking to establish the optimal operating conditions of HP and studies focusing on defining the optimal timing, dose, and duration of these therapies could help define future clinical applications.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"88-97"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9959568","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

Adsorption of Endotoxin and Mitigation of Sepsis. 内毒素的吸附和脓毒症的缓解。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527708

John A Kellum, Hisataka Shoji, Debra M Foster, Paul M Walker

{"title":"Adsorption of Endotoxin and Mitigation of Sepsis.","authors":"John A Kellum, Hisataka Shoji, Debra M Foster, Paul M Walker","doi":"10.1159/000527708","DOIUrl":"10.1159/000527708","url":null,"abstract":"In the fields of sepsis and systemic inflammation, endotoxin might be the most studied molecule since the term was coined by Richard Pfeiffer in 1892. Paradoxically measuring endotoxin in humans and finding an effective treatment for endotoxemia have remained challenging. While advances have been made in understanding the mechanisms of how this simple molecule can trigger an intense immune cascade, there is an ever growing need to develop better treatments. Studies measuring endotoxin levels in patients with septic shock have consistently demonstrated that there is a dose-response relationship between endotoxin levels and adverse outcomes. A rapid assay to measure endotoxin activity has been available for more than a decade, but few studies have synergized the assay with a therapeutic. Polymyxin B hemoperfusion (PMX-HP) leverages a molecule with high affinity for endotoxin with a technique to eliminate exposure. Polymyxin is bound and immobilized to fibers within a cartridge and administered as an extracorporeal therapy via veno-venous hemoperfusion. Clinical evidence of its use is plentiful yet inconsistent in studies based on an outcome for mortality at 28 days. Herein, we describe targeted patient selection using the endotoxin activity assay and clinical phenotyping followed by adsorption of endotoxin using the PMX-HP for endotoxemic sepsis.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"133-141"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9954263","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 and Immunomodulation. 血液灌注和免疫调节。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529885

Claudio Ronco, Sara Samoni, Rinaldo Bellomo

引用次数: 0

Hemoperfusion with CytoSorb®: Current Knowledge on Patient Selection, Timing, and Dosing. CytoSorb®血液灌注：患者选择、时间和给药的最新知识。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000527774

Gerd Klinkmann, Sebastian Koball, Daniel A Reuter, Steffen Mitzner

{"title":"Hemoperfusion with CytoSorb®: Current Knowledge on Patient Selection, Timing, and Dosing.","authors":"Gerd Klinkmann, Sebastian Koball, Daniel A Reuter, Steffen Mitzner","doi":"10.1159/000527774","DOIUrl":"10.1159/000527774","url":null,"abstract":"Direct hemoperfusion with the CytoSorb® adsorbent has experienced widespread use in several critical care settings including sepsis and multiorgan failure. The reported conditions of clinical usage and resulting outcomes vary considerably. The aim of the study was to provide an overview on current treatment recommendations based on the available clinical evidence. We performed a literature analysis using PubMed/MEDLINE and ClinicalTrials.gov to identify clinical data describing parameters of clinical usage of CytoSorb® in patients with septic shock (inclusion and exclusion criteria, starting, and dosing of treatment) and their impact on outcome. The literature search terms <CytoSorb and sepsis> yielded 146 entries in September 2022, including clinical case reports, case series, and controlled and uncontrolled clinical trials. Five recommendations were identified linking usage parameters with improved outcome. These were (a) early start of treatment within 12-24 h after onset of septic shock, (b) individualized patient selection (preferably with higher severity scores, procalcitonin >3 ng/mL, serum interleukin 6 >500 pg/mL), (c) exclusion of patients with lactate ≥6 mmol/L or platelets <100 GPT/L, (d) intense treatment (>6 L of blood/kg body weight), and (e) early change of the adsorbent (e.g., every 12 h). Moreover, there is a rationale suggesting therapeutic drug monitoring when possible, avoidance of drug application at the beginning of treatment, and/or usage of increased dosages of antibiotics. However, for the later recommendations, no links to clinical outcome were reported yet. All recommendations are based on the best available knowledge. They need confirmation in future clinical investigations. Currently available clinical data on the use of CytoSorb® in septic patients suggest that early and intense treatment in carefully chosen patients increases the chance of survival. The analysis can inform current clinical practice and future clinical trials.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"17-24"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9954267","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

History and Development of Sorbents and Requirements for Sorbent Materials. 吸附剂的历史和发展以及对吸附材料的要求。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-01 DOI: 10.1159/000529569

Claudio Ronco, Rinaldo Bellomo

引用次数: 0

Adsorption of Pathogens and Blockade of Sepsis Cascade. 病原体的吸附和脓毒症级联的阻断。

4区医学

Contributions to nephrology Pub Date : 2023-01-01 Epub Date: 2023-06-22 DOI: 10.1159/000527648

Ian J Stewart, Keith McCrea, Lakhmir Chawla, Kevin K Chung

{"title":"Adsorption of Pathogens and Blockade of Sepsis Cascade.","authors":"Ian J Stewart, Keith McCrea, Lakhmir Chawla, Kevin K Chung","doi":"10.1159/000527648","DOIUrl":"10.1159/000527648","url":null,"abstract":"Sepsis is caused by the host response to an infectious organism. It is common among hospitalized patients and is associated with significant morbidity and mortality. The current standard of care for sepsis is predominantly supportive, with early detection followed by prompt antibiotic administration. While this approach has undoubtedly improved patient outcomes, it has significant limitations. First, mortality from sepsis remains unacceptably high. Second, emerging pathogen resistance to antimicrobial therapies threatens a return to the pre-antimicrobial era of patient care. Lastly, the early stages of a pandemic (e.g., the recent coronavirus 19 pandemic) lack effective therapeutics. Given these limitations, novel treatment strategies are needed to advance the field and care for patients. One potential class of therapy is extracorporeal blood purification (EBP). While EBP is a broad classification, encompassing a wide range of techniques, this article will focus on three emerging EBP therapies that have been shown to bind and remove a wide variety of viral, bacterial, and fungal pathogens directly from circulation. These devices utilize different mechanisms of action for pathogen removal. The Seraph® 100 is composed of heparin coated beads. The Hemopurifier® combines the concept of plasma exchange with mannose-binding lectin (MBL). Lastly, the GARNET® utilizes a MBL fused to an IgG antibody. Via these mechanisms, these devices have been demonstrated to remove pathogens and pathogen-associated molecular patterns. The hope is that by directly removing pathogens, these EBP techniques may result in the biggest breakthrough in the management of sepsis since the advent of antibiotics almost 100 years ago.","PeriodicalId":10725,"journal":{"name":"Contributions to nephrology","volume":"200 ","pages":"123-132"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10329214","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