International Journal of Artificial Organs最新文献

{"title":"Berlin Heart EXCOR in pediatric heart failure: Bridging long-lasting and complex conditions to transplant.","authors":"Raffaele Abete, Ottavio Zucchetti, Attilio Iacovoni, Claudia Vittori, Roberta Sebastiani, Francesca Julia Papesso, Francesco Seddio, Amedeo Terzi","doi":"10.1177/03913988261479957","DOIUrl":"https://doi.org/10.1177/03913988261479957","url":null,"abstract":"<p><strong>Background: </strong>Advanced heart failure (advHF) in pediatric patients often requires prolonged mechanical circulatory support (MCS) as a bridge-to-transplant or bridge-to-recovery. Due to donor scarcity and anatomical complexity, pediatric patients frequently face long MCS durations and high complication risks. The Berlin Heart EXCOR is an approved ventricular assist device (VAD) with versatile configurations adaptable to specific patient needs.</p><p><strong>Methods: </strong>This study analyzed demographic, clinical, echocardiographic, and hemodynamic data from the Heart Transplant Unit at ASST-Papa Giovanni XXIII (Bergamo, Italy). The research focused on advHF management using prolonged MCS as a bridge-to-transplant, detailing Berlin Heart EXCOR configurations, settings, support duration, and complications.</p><p><strong>Results: </strong>Three pediatric patients with distinct etiologies received prolonged MCS via Berlin Heart EXCOR. The first, with genetic dilated cardiomyopathy, required a left ventricular EXCOR. The second, with early-onset cardiomyopathy and biventricular failure, received biventricular support. The third, with complex congenital heart disease (CHD), was supported by a single EXCOR. Despite varying ages and cardiac anatomies, all three patients were successfully bridged to heart transplantation without irreversible extracardiac organ damage.</p><p><strong>Conclusions: </strong>This case series demonstrates the effectiveness of long-lasting MCS in providing sustained hemodynamic stability for pediatric patients. The Berlin Heart EXCOR proved to be a reliable long-term support option in both univentricular and biventricular settings.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261479957"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880309","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}

{"title":"Intravascular hemolysis and clinical outcomes in continuous-flow LVAD patients: A single-center retrospective analysis.","authors":"Ali Onder Kilic, Cagatay Engin, Tahir Yagdi, Mustafa Ozbaran","doi":"10.1177/03913988261479983","DOIUrl":"https://doi.org/10.1177/03913988261479983","url":null,"abstract":"<p><strong>Objective: </strong>To determine the incidence of intravascular hemolysis in patients implanted with continuous-flow left ventricular assist devices (LVADs), to describe longitudinal changes in hemolysis-related laboratory markers (LDH, total/direct bilirubin, INR), and to assess their diagnostic value for pump thrombosis and cerebrovascular events.</p><p><strong>Methods: </strong>We retrospectively analyzed 100 end-stage heart failure patients (2014-2015). To ensure consistent longitudinal analysis, 59 long-term survivors (42 HeartWare HVAD, 17 HeartMate II) were included. For each patient, a dynamic LDH increase ratio (peak/preoperative baseline) was calculated. The diagnostic performance of the criterion \"LDH >250 U/L and ⩾4-fold increase from baseline\" was evaluated. Cox regression, ROC analysis, and Kaplan-Meier survival analysis were performed.</p><p><strong>Results: </strong>During 1-year follow-up, 17 patients experienced thrombotic or cerebrovascular events (8 confirmed pump thrombosis). While absolute LDH values at fixed time points were not discriminative, the dynamic LDH increase ratio was significantly higher in the thrombosis group (<i>p</i> = 0.0102), with an AUC of 0.840. Preoperative LDH was a significant risk factor in Cox regression (HR: 1.005, <i>p</i> = 0.009), reflecting baseline disease severity. The ⩾4-fold LDH increase criterion demonstrated a Negative Predictive Value (NPV) of 97.6%, indicating excellent rule-out performance. No significant difference was found between device types (<i>p</i> > 0.05), supporting a device-independent biomarker dynamic.</p><p><strong>Conclusion: </strong>Baseline LDH alone is not a reliable predictor of pump thrombosis. In contrast, a ⩾4-fold dynamic rise in LDH relative to the patient's own baseline provides excellent negative predictive value. This dynamic surge serves as a practical, device-independent decision-support tool to rule out pump thrombosis with high confidence in all cf-LVAD patients.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261479983"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873758","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}

{"title":"Therapeutic effects of Huangqi Jixueteng decoction combined with erythropoietin on iron metabolism in in patients with renal anemia.","authors":"Shanzhai Wei, Yilai Zhang, Kangchun Xu, Man Wang","doi":"10.1177/03913988261474704","DOIUrl":"https://doi.org/10.1177/03913988261474704","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the therapeutic effects of Huangqi Jixueteng Decoction (HJD) combined with erythropoietin on iron metabolism in patients with renal anemia undergoing maintenance hemodialysis.</p><p><strong>Methods: </strong>Sixty patients with renal anemia receiving maintenance hemodialysis were randomly assigned to a Control Group (CG) treated with erythropoietin alone and an Observation Group (OG) treated with erythropoietin plus HJD. Changes in anemia-related indicators (red blood cell (RBC) count, hematocrit (HCT), hemoglobin (Hb)), inflammatory markers (tumor necrosis factor-α (TNF-α), C-reactive protein (CRP)), iron metabolism parameters (serum ferritin (SF), serum iron (SI), total iron-binding capacity (TIBC), transferrin saturation (TSAT)), and renal and hepatic function indicators (blood urea nitrogen (BUN), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST)) were compared between groups. Adverse drug reactions were also monitored.</p><p><strong>Results: </strong>Baseline values showed no significant differences between groups (<i>p</i> > 0.05). Post-treatment, RBC, HCT, and Hb levels increased significantly in both groups (<i>p</i> < 0.05), with greater improvement in the OG (<i>p</i> < 0.05). Inflammatory markers declined in both groups, with CRP and TNF-α levels significantly lower in the OG compared with the CG (<i>p</i> < 0.05). Indicators of iron metabolism (SF, SI, TIBC, TSAT) improved significantly in both groups (<i>p</i> < 0.05), with superior responses in the OG (<i>p</i> < 0.05). Renal and hepatic function indexes (BUN, Scr, AST) decreased post-treatment in both groups, with lower levels in the OG (<i>p</i> < 0.05). No significant differences were observed in adverse reactions such as dizziness, headache, or low-grade fever (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>The addition of Huangqi Jixueteng Decoction to erythropoietin therapy effectively enhances hematologic parameters, mitigates microinflammation, optimizes iron metabolism, and improves renal function in patients with dialysis-associated renal anemia. This integrative regimen appears safe and well tolerated, offering potential advantages for clinical management of renal anemia.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261474704"},"PeriodicalIF":1.6,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880306","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}

{"title":"Modulation of dialysate temperature and its impact on post-dialysis fatigue and thermal comfort: A pre-post interventional study.","authors":"Gülay Turgay, Banu Çevik, Sultan Kav, Mustafa Gülşen, Işılay İnanoğlu, Semiha Kaya, Cihat Burak Sayın","doi":"10.1177/03913988261479989","DOIUrl":"https://doi.org/10.1177/03913988261479989","url":null,"abstract":"<p><strong>Background: </strong>Post-dialysis fatigue is a frequent and burdensome symptom in patients undergoing maintenance hemodialysis. While intradialytic symptoms are commonly monitored in clinical practice, symptoms emerging after dialysis and affecting post-dialysis recovery are often less systematically addressed. This study evaluated the effects of a reduced dialysate temperature on post-dialysis fatigue and thermal comfort.</p><p><strong>Methods: </strong>This single-group pre-post interventional study was conducted between May and June 2025 at a dialysis center. Of the 220 screened patients, 130 met the eligibility criteria after the predefined clinical exclusions. Patients with Post-Dialysis Fatigue Scale scores ⩾28 were included in the intervention phase (<i>n</i> = 57). The dialysate temperature was reduced from 36.5°C to 36.0°C for three consecutive sessions. Thermal comfort was assessed using a numerical visual analog scale. Data were analyzed using repeated-measures ANOVA, correlation, and regression analyses.</p><p><strong>Results: </strong>Post-dialysis fatigue significantly decreased after the intervention (<i>F</i> = 25.82, <i>p</i> < 0.001; <i>d</i>_z = 0.91). Changes in systolic blood pressure independently predicted fatigue improvement (β = -0.557, <i>p</i> = 0.019). Thermal comfort remained stable during the intervention.</p><p><strong>Conclusion: </strong>Reducing the dialysate temperature may be a feasible approach to alleviate post-dialysis fatigue without compromising thermal comfort.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261479989"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873872","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}

{"title":"Pediatric intracorporeal LVAD support in the transition from HVAD to HeartMate 3.","authors":"Sedat Karaca, Osman Nuri Tuncer, Ümit Kahraman, Dilek Erdinli, Eser Doğan, Zulal Ulger Tutar, Cagatay Engin, Yuksel Atay, Tahir Yagdi, Mustafa Ozbaran","doi":"10.1177/03913988261480648","DOIUrl":"https://doi.org/10.1177/03913988261480648","url":null,"abstract":"<p><strong>Background: </strong>The withdrawal of the HeartWare HVAD required pediatric mechanical circulatory support programs to transition to alternative durable intracorporeal devices. We evaluated our single-center experience across the HVAD and HeartMate 3 (HM3) eras.</p><p><strong>Methods: </strong>We retrospectively reviewed all pediatric patients who underwent primary durable intracorporeal LVAD implantation between January 2012 and December 2024. Clinical characteristics, perioperative outcomes, survival on support, bridge-to-transplantation, and device-related adverse events were compared.</p><p><strong>Results: </strong>Thirty-four patients were included: 22 received HVAD and 12 received HM3. Baseline characteristics were generally comparable. Cardiopulmonary bypass time was significantly longer in the HM3 group (<i>p</i> < 0.001). Median support duration was longer with HVAD (1002 vs 838 days; <i>p</i> = 0.304). Survival on LVAD support did not differ between groups (log-rank <i>p</i> = 0.375). Pump thrombosis (40.9% vs 0%; <i>p</i> = 0.013) and ischemic stroke (27.3% vs 0%; <i>p</i> = 0.069) occurred only in HVAD recipients, whereas infectious complications were comparable between groups.</p><p><strong>Conclusions: </strong>HM3 appears to be a feasible intracorporeal long-term support option for selected pediatric patients in the post-HVAD era. Longer-term multicenter pediatric studies are needed to define durability, late complications, and optimal patient selection.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261480648"},"PeriodicalIF":1.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873858","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}

{"title":"Tolerance-aware robust ranking of ventricular assist device rotor designs using strict feasibility and percentile-based criteria.","authors":"Mohamed Bounouib, Reda Lakraimi, Hamza Isksioui, Mourad Taha-Janan, Wajih Maazouzi","doi":"10.1177/03913988261479034","DOIUrl":"https://doi.org/10.1177/03913988261479034","url":null,"abstract":"<p><p>Manufacturing variability can alter the hydraulic and hemocompatibility performance of a ventricular assist device (VAD) rotor even when the nominal design is computationally optimal. This study presents a surrogate-assisted robust-design workflow for a rotary VAD using a CFD-derived design-of-experiments database of 4809 rotor geometries defined by six input variables and seven performance outputs. Output-specific surrogate models were selected from linear regression, quadratic response-surface models, support-vector regression, random forests, gradient boosting, and multilayer perceptrons using five-fold cross-validated <i>R</i>², yielding values from 0.7367 to 0.9966. The 16 best nominal designs were then propagated through 2500 surrogate-evaluated Monte Carlo realizations under four manufacturing-tolerance scenarios ranging from mild to extreme. Nominal ranking was based on the geometric mean of normalized desirability functions, whereas robust ranking combined scaled nominal desirability, feasibility probability, percentile-based desirability, and a degradation penalty. D1297 was the nominal optimum (<i>D</i> = 0.8125), but D717 became the preferred robust design under mild and moderate tolerances, with robust scores of 0.9031 and 0.8741, respectively. Under severe and extreme perturbations, D174 emerged as the leading candidate because it retained the best conservative percentile behavior and the smallest degradation while preserving full feasibility. Local sensitivity analysis identified clearance gap and rotor length as the dominant robustness drivers. The results show that production-oriented VAD design selection can differ materially from nominal optimization and that tolerance-aware ranking provides a surrogate-assisted computational screening basis for prioritizing rotor candidates before direct CFD confirmation, prototype fabrication, dimensional metrology, and experimental hemocompatibility testing.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261479034"},"PeriodicalIF":1.6,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857160","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}

{"title":"CORVAD 4.0-assisted complex left main PCI in high-risk acute coronary syndrome with SCAI stage C cardiogenic shock: A case report.","authors":"Wenfang Zhu, Xiaofei Xie, Xiaoliang Han, Yuhong Chen, Liang Li, Guangcheng Sun, Shengxin Zuo, Jinpeng Xu","doi":"10.1177/03913988261479046","DOIUrl":"https://doi.org/10.1177/03913988261479046","url":null,"abstract":"<p><p>Temporary left ventricular support may be considered when cardiogenic shock and complex left main percutaneous coronary intervention (PCI) overlap, but the procedure depends on more than pump placement alone. We describe an 80-year-old man with high-risk acute coronary syndrome, ongoing ischemia for more than 12 h, SCAI stage C cardiogenic shock, left ventricular ejection fraction of 39%, and severe distal left main bifurcation disease in a left-dominant coronary system. Coronary angiography was performed through the right distal radial artery. Before femoral cannulation, the same radial access was used as an adjunct to obtain right iliofemoral angiographic information. After the femoral route was judged suitable, CORVAD 4.0 was implanted through the right femoral artery and provided approximately 2.1 L/min of support at level S5. PCI was performed through the right distal radial artery using a 7F EBU 3.0 guiding catheter. Intravascular ultrasound-guided DK-crush PCI was completed with final TIMI 3 flow. The device was kept in place for short-term intensive care support and removed once hemodynamics and end-organ perfusion had improved sufficiently, after fever and coagulase-negative staphylococcal blood culture growth raised concern for possible device- or access-related infection. Infection was subsequently controlled, and the patient was discharged after 11 days. This case illustrates a stepwise approach to temporary support, access assessment, complex PCI, and timely device removal when the clinical risk profile changes.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261479046"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840086","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}

{"title":"Impella 5.5 as a bridge to dual-organ transplantation.","authors":"Wyatt Klass, Alex C Crane, George Chachati, Nicole Kunz, Ryan M Rivosecchi, Mohamed Abdullah, Raj Ramanan, Jonathan D Wolfe, Mary Keebler, Edward T Horn, David Kaczorowski, Gavin Hickey","doi":"10.1177/03913988261476499","DOIUrl":"https://doi.org/10.1177/03913988261476499","url":null,"abstract":"<p><p>The Impella 5.5 is increasingly utilized as temporary mechanical circulatory support to bridge patients in cardiogenic shock to heart transplantation. Patients listed for dual-organ transplantation may experience longer wait times than heart transplant alone. We aimed to evaluate the feasibility of Impella 5.5 as a bridge to dual-organ transplant. We performed a retrospective review of patients with cardiogenic shock supported with Impella 5.5 who subsequently underwent heart transplant or dual-organ transplant from 2021 to 2025. Dual-organ transplant included combined heart-kidney, heart-liver, and heart-lung transplants. Fifty-four total patients received Impella 5.5 bridge, for which six were dual-organ transplants. Blood type A was most common among both groups (heart transplant 39.6%, dual-organ transplant 66.7%). Median ages were 56 (IQR 46.5-61.2) for isolated heart transplants and 57.5 (IQR 37.5-62) years old for dual-organ transplants. All patients were SCAI class C or higher. Non-ischemic cardiomyopathy was the predominant etiology (heart transplant 100%, dual-organ transplant 83%). Dual organ transplant recipients underwent heart-kidney (<i>n</i> = 3), heart-lung (<i>n</i> = 1), or heart-liver (<i>n</i> = 2) transplants, with median Impella 5.5 support durations of 117, 19, and 42 days, respectively. This is compared to a median support duration of 14 days for isolated heart transplant recipients. Detailed baseline characteristics and post-transplant outcomes were similar across subgroups. Use of Impella 5.5 as a bridge to dual-organ transplants is feasible and safe in selected patients with cardiogenic shock with multi-organ failure. Further studies are needed to assess laboratory data, hemodynamics trajectories, and long-term survival outcomes in this population.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261476499"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840095","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}

{"title":"Regulatory role of permissive hypercapnia in inflammatory response and postoperative recovery: Evidence from laparoscopic surgery patients.","authors":"Jingjing Cui, Tao Jin, Bao Zhang","doi":"10.1177/03913988261467178","DOIUrl":"https://doi.org/10.1177/03913988261467178","url":null,"abstract":"<p><strong>Objective: </strong>As a lung-protective ventilation strategy, the regulatory effects of permissive hypercapnia on inflammatory mediators and clinical outcomes during laparoscopic surgery remain insufficiently clarified. This study investigated the impact of permissive hypercapnia on perioperative cytokine profiles and patient recovery in laparoscopic procedures.</p><p><strong>Methods: </strong>A retrospective analysis was conducted including 72 patients who received permissive hypercapnia ventilation (observation group) and 58 patients who underwent conventional ventilation (control group). Serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor-alpha (TNF-α), the oxygenation index (OI), and alveolar-arterial oxygen difference (P(A-a) O₂) were measured at multiple perioperative time points. Surgery-related indicators and postoperative complications were recorded.</p><p><strong>Results: </strong>At 24 h postoperatively, the observation group exhibited significantly lower IL-6 and TNF-α concentrations and higher IL-10 levels compared with the control group (<i>p</i> < 0.05). At 30 min after pneumoperitoneum and 24 h postoperatively, both OI and P(A-a) O₂ were higher in the observation group, whereas at the end of surgery they were slightly lower than in the control group (all <i>p</i> < 0.05). Extubation time (17.49 ± 3.62 min), hospital stay (5.67 ± 1.24 days), and complication rate (12.50%) were significantly improved in the observation group versus controls (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Permissive hypercapnia effectively modulates the balance of IL-6, IL-10, and TNF-α, enhances pulmonary oxygenation, attenuates perioperative inflammation, accelerates postoperative recovery, and reduces complications. These findings support its value as a lung-protective ventilation strategy in laparoscopic surgery.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261467178"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840098","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}

{"title":"Toward a conceptual framework for systemic effects of continuous renal replacement therapy in critical illness.","authors":"Yusuke Nishimura","doi":"10.1177/03913988261473824","DOIUrl":"https://doi.org/10.1177/03913988261473824","url":null,"abstract":"<p><p>Continuous renal replacement therapy (CRRT) is traditionally used for solute and fluid removal in critically ill patients with acute kidney injury. Emerging evidence suggests that CRRT may also influence systemic biological networks, including inflammation, vascular function, immunity, and metabolism. In sepsis and critical illness, these systems are dynamically dysregulated, involving fluctuating inflammatory mediators, endothelial alterations, immune dysfunction ranging from hyperinflammation to immunoparalysis, and metabolic reprogramming that varies with disease stage. We propose a conceptual framework in which CRRT modulates these interconnected processes. Beyond solute and cytokine removal, CRRT may affect the distribution of circulating mediators, attenuate concentration peaks, influence endothelial stability, and modulate immune and metabolic states, thereby contributing to systemic network regulation. However, CRRT has bidirectional effects. While it may help restore homeostasis by removing harmful mediators, it may also eliminate beneficial molecules and induce inflammatory or oxidative responses due to extracorporeal circulation. Therefore, its overall impact is likely context-dependent and influenced by treatment settings and patient condition. Although direct evidence for systemic reprogramming remains limited, this framework provides a basis for future research. Integrative biomarker-based and phenotyping approaches may support the development of individualized and adaptive CRRT strategies in critical care.</p>","PeriodicalId":13932,"journal":{"name":"International Journal of Artificial Organs","volume":" ","pages":"3913988261473824"},"PeriodicalIF":1.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840158","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}