Blood Purification最新文献

Kinetics of different blood biomarkers during Polymyxin-B extracorporeal hemoperfusion in abdominal sepsis. 腹腔败血症患者在多粘菌素-B 体外血液灌流过程中不同血液生物标志物的动力学。

Blood Purification Pub Date : 2024-04-23 DOI: 10.1159/000538870

A. Cotoia, Valeria Parisano, Paola Sara Mariotti, Vincenzo Lizzi, G. Netti, Elena Ranieri, Francesco Forfori, Gilda Cinnella

{"title":"Kinetics of different blood biomarkers during Polymyxin-B extracorporeal hemoperfusion in abdominal sepsis.","authors":"A. Cotoia, Valeria Parisano, Paola Sara Mariotti, Vincenzo Lizzi, G. Netti, Elena Ranieri, Francesco Forfori, Gilda Cinnella","doi":"10.1159/000538870","DOIUrl":"https://doi.org/10.1159/000538870","url":null,"abstract":"Introduction Comparison of the marker kinetics procalcitonin, presepsin and endotoxin during extracorporeal hemoperfusion with polymyxin B adsorbing cartridge (PMX-HA) have never been described in abdominal sepsis. We aim to compare the trend of three biomarkers in septic post-surgical abdominal patients in Intensive care Unit (ICU) treated with PMX-HA and their prognostic value. Methods Ninety abdominal postsurgical patients were enrolled into different groups according to the evidence of postoperative sepsis or not. Non-septic patients admitted in the surgical ward were included in C group (control group). ICU septic shock patients with endotoxin levels <0.6 EAA receiving conventional therapy were addressed in S group and those with endotoxin levels ≥0.6 EAA receiving treatment with PMX-HA, besides conventional therapy, were included in SPB group. Presepsin, procalcitonin, endotoxin and other clinical data were recorded at 24h (T0), 72h (T1) and 7 days (T2) after surgery. Clinical follow-up was performed on day 30. Results SPB group showed reduced levels of the three biomarkers on T2 vs T0 (P<0.001); presepsin, procalcitonin and endotoxin levels decreased respectively of 25%, 11% and 2% on T1 vs T0, and of 40%, 41%, 26% on T2 vs T0. All patients in C group, 73% of patients in SPB group vs 37% of patients in S group survived at follow-up. Moreover, procalcitonin had the highest predictive value for mortality at 30 days, followed by presepsin. Conclusion The present study showed the reliability of presepsin in monitoring PMX-HA treatment in septic shock patients. Procalcitonin showed better predicting power for the mortality risk.","PeriodicalId":505290,"journal":{"name":"Blood Purification","volume":"24 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

CCL14 Predicts Oliguria and Dialysis Requirement in Patients with Moderate to Severe Acute Kidney Injury. CCL14可预测中度至重度急性肾损伤患者的少尿和透析需求。

Blood Purification Pub Date : 2024-04-18 DOI: 10.1159/000538898

S. Demirjian, Lakhmir Chawla, Danielle L Davison, L. Forni, Michael Heung, Eric A. Hoste, J. Koyner, J. P. Kampf, Thomas Kwan, Paul Mcpherson, John A Kellum

{"title":"CCL14 Predicts Oliguria and Dialysis Requirement in Patients with Moderate to Severe Acute Kidney Injury.","authors":"S. Demirjian, Lakhmir Chawla, Danielle L Davison, L. Forni, Michael Heung, Eric A. Hoste, J. Koyner, J. P. Kampf, Thomas Kwan, Paul Mcpherson, John A Kellum","doi":"10.1159/000538898","DOIUrl":"https://doi.org/10.1159/000538898","url":null,"abstract":"INTRUDUCTION\u0000AKI is a frequent complication in critical illness and portends poor outcome. CCL14 has been validated to predict persistent severe AKI in critically ill patients. We examined the association of CCL14 with urine output within 48 hours.\u0000\u0000\u0000METHODS\u0000In pooled data from 2 studies of critically ill patients with KDIGO stage 2-3 AKI, CCL14 was measured by NEPHROCLEAR™CCL14 Test on the Astute 140® Meter, and divided to low, intermediate and high categories (1.3 and 13 ng/mL). Average hourly urine output over 48 hours, stage 3 AKI per urine output criterion on day 2, and composite of dialysis or death within 7 days were examined using multivariable mixed, and logistic regression models.\u0000\u0000\u0000RESULTS\u0000Of the 497 subjects with median age of 65 [56-74] years, 49% (242/497) were on diuretics. CCL14 concentration was low in 219 (44%), intermediate in 217 (44%), and high in 61 (12%) patients. In mixed regression analysis, urine output trajectory over time was different within each CCL14 risk category based on diuretic use due to significant three-way interaction (p < 0.001). In logistic regression analysis CCL14 risk category was independently associated with low urine output on day 2 (KDIGO stage 3) adjusted for diuretic use and baseline clinical variables and composite of dialysis or death within 7 days (adjusted for urine output within 48 hours of CCL14 measurement).\u0000\u0000\u0000CONCLUSIONS\u0000CCL14 measured in patients with moderate to severe AKI is associated with urine output trajectory within 48 hours, oliguria on day 2, and dialysis within 7 days.","PeriodicalId":505290,"journal":{"name":"Blood Purification","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Current fluid management practice in critically ill adults on continuous renal replacement therapy: A binational, observational study. 接受持续肾脏替代疗法的成人重症患者目前的液体管理实践：一项两国观察性研究。

Blood Purification Pub Date : 2024-04-16 DOI: 10.1159/000538421

Kyle C White, Kevin B. Laupland, M. Ostermann, Ary Serpa Neto, Michelle Gatton, R. Hurford, Pierre Clement, Barnaby Sanderson, R. Bellomo

{"title":"Current fluid management practice in critically ill adults on continuous renal replacement therapy: A binational, observational study.","authors":"Kyle C White, Kevin B. Laupland, M. Ostermann, Ary Serpa Neto, Michelle Gatton, R. Hurford, Pierre Clement, Barnaby Sanderson, R. Bellomo","doi":"10.1159/000538421","DOIUrl":"https://doi.org/10.1159/000538421","url":null,"abstract":"Introduction In critically ill patients undergoing continuous renal replacement therapy (CRRT), a positive fluid balance (FB) is associated with adverse outcomes. However, current FB management practices in CRRT patients are poorly understood. We aimed to study FB and its components in British and Australian CRRT patients to inform future trials. Methods We obtained detailed electronic health record data on all fluid-related variables during CRRT and hourly FB for the first seven days of treatment. Results We studied 1,616 patients from three tertiary ICUs in two countries. After the start of CRRT, the mean cumulative FB became negative at 31 hours and remained negative over seven days to a mean nadir of -4.1 L (95% confidence intervals (CI) of -4.6 to -3.5). The net ultrafiltration (NUF) rate was the dominant fluid variable (-67.7 mL/h; SD 75.7); however, residual urine output (-34.7 mL/h; SD 54.5), crystalloid administration (48.1 mL/h; SD 44.6), and nutritional input (36.4 mL/h; SD 29.7) significantly contributed to FB. Patients with a positive FB after 72 hours of CRRT, were more severely ill, required high-dose vasopressors and had high lactate concentrations (5.0 mmol/L; IQR 2.3 - 10.5). A positive FB was independently associated with increased hospital mortality (OR 1.70; 95% CI; p=0.004). Conclusion In the study ICUs, most CRRT patients achieved a predominantly NUF-dependent negative FB. Patients with a positive FB at 72 hours had greater illness severity and haemodynamic instability. Achieving equipoise for conducting trials that target a negative early FB in such patients may be difficult.","PeriodicalId":505290,"journal":{"name":"Blood Purification","volume":"37 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nuances of POCUS in Nephrology: A Clarion Call for Deeper Understanding. 肾脏病学中 POCUS 的细微差别：深入理解的号角。

Blood Purification Pub Date : 2024-04-15 DOI: 10.1159/000538909

A. Kazory, Olanrewaju A. Olaoye, Abhilash Koratala

引用次数: 0

Pharmacokinetic Research in Pediatric Extracorporeal Therapies: Current State and Future Directions 儿科体外疗法的药代动力学研究：现状与未来方向

Blood Purification Pub Date : 2024-02-28 DOI: 10.1159/000534828

Gideon Stitt, Céline Thibault, Bruce A. Mueller, Jeffrey J. Cies, Jennifer Morris Daniel, Ayse Akcan Arikan, Kevin M. Watt

{"title":"Pharmacokinetic Research in Pediatric Extracorporeal Therapies: Current State and Future Directions","authors":"Gideon Stitt, Céline Thibault, Bruce A. Mueller, Jeffrey J. Cies, Jennifer Morris Daniel, Ayse Akcan Arikan, Kevin M. Watt","doi":"10.1159/000534828","DOIUrl":"https://doi.org/10.1159/000534828","url":null,"abstract":"Extracorporeal life support (ECLS), including extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT), are life-saving therapies for critically ill children. Despite this, these modalities carry frustratingly high mortality rates. One driver of mortality may be altered drug disposition due to a combination of underlying illness, patient-circuit interactions, and drug-circuit interactions. Children receiving ECMO and/or CRRT routinely receive 20 or more drugs, and data supporting optimal dosing is lacking for most of these medications. The Pediatric Paracorporeal and Extracorporeal Therapies Summit (PPETS) gathered an international group of experts in the fields of ECMO, CRRT, and other ECLS modalities to discuss the current state of these therapies, disseminate innovative support strategies, share clinical experiences, and foster future collaborations. Here, we summarize the conclusions of PPETS and put forward a pathway to optimize pharmacokinetic (PK) research in this population. We must prioritize specific medications for in-depth study to improve drug use in ECLS and patient outcomes. Based on frequency of use, potential for adverse outcomes if dosed inappropriately, and lack of existing PK data, a list of high priority drugs was compiled for future research. Researchers must additionally reconsider study designs, emphasizing pooling of resources through multi-center studies and the use of innovative PK modeling techniques. Finally, the integration of validated PK models into clinical practice must be streamlined to deliver optimal medication use at the bedside. Focusing on the proposed list of highlighted medications and key methodological considerations will maximize the impact of future research.","PeriodicalId":505290,"journal":{"name":"Blood Purification","volume":"59 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140419501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

With the Generalization of AI and Algorithms, Will We Still Need a Nephrologist in the Dialysis Room? 随着人工智能和算法的普及，透析室里还需要肾病专家吗？

Blood Purification Pub Date : 2024-01-22 DOI: 10.1159/000536074

Amr Maoujoud, Mohamemd Asserraji, F. Laboudi, Samir Ahid, Rachida Parks

引用次数: 0