Simona Barbuto, Lorenza Magagnoli, Giuseppe Cianciolo, Gaetano La Manna, Paola Ciceri, Mario Cozzolino
{"title":"MCO Membranes and FGF23: Advancing Dialysis Strategies for Better Outcomes?","authors":"Simona Barbuto, Lorenza Magagnoli, Giuseppe Cianciolo, Gaetano La Manna, Paola Ciceri, Mario Cozzolino","doi":"10.1159/000547457","DOIUrl":"https://doi.org/10.1159/000547457","url":null,"abstract":"<p><p>n/a.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-6"},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arnau Ulsamer, Diego Pomare Montin, Vittorio Bocciero, Tania Julieth Parra Morales, Lorenzo Tofani, Luca Di Girolamo, Stefano Romagnoli, Gianluca Villa, Matteo Cecchi
{"title":"Interleukin-6 removal and clinical effects of Oxiris: a systematic review and meta-analysis.","authors":"Arnau Ulsamer, Diego Pomare Montin, Vittorio Bocciero, Tania Julieth Parra Morales, Lorenzo Tofani, Luca Di Girolamo, Stefano Romagnoli, Gianluca Villa, Matteo Cecchi","doi":"10.1159/000547587","DOIUrl":"https://doi.org/10.1159/000547587","url":null,"abstract":"<p><p>Introduction Sepsis is a life-threatening condition associated with high mortality due to an unregulated host immune response. Extracorporeal blood purification (EBP) therapies have been proposed as adjunctive treatments to immunomodulate patients; however, none have been consistently shown to be effective in reducing mortality. In several observational studies, Oxiris has been associated with cytokine reduction and a potential benefit in influencing inflammatory diseases. This meta-analysis explores the association between cytokine removal and clinical efficacy of the Oxiris membrane using interleukin-6 (IL-6) as a biomarker. Methods This review includes articles on EBP with Oxiris membranes in adult patients with sepsis/septic shock or COVID-19. No time or language restrictions were applied to the systematic literature search. Data extraction and statistical analysis were limited to the cytokines and clinical data reported in the included articles. The most representative cytokine was IL-6 and the selected outcomes included VIS (Vasoactive-Inotropic Score), SOFA score, procalcitonin (PCT) and c-reactive protein (CRP). The review used meta-analysis and unpaired t-test to estimate differences between groups of patients treated with or without Oxiris. Results The study found no significant differences in demographics between the intervention and control groups at baseline. Intervention group showed a significant reduction in vasoactive inotropic score, norepinephrine dose, SOFA score, procalcitonin and C-reactive protein. Conclusion We reviewed 8 studies in which IL-6 was significantly reduced in the Oxiris group compared to the control. This meta-analysis found that the use of the Oxiris membrane resulted in significant clinical improvement during treatment.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-17"},"PeriodicalIF":1.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non sibi sed omnibus: Chronic Dialysis Care Through a Stakeholder Lens.","authors":"José A Moura-Neto","doi":"10.1159/000547615","DOIUrl":"https://doi.org/10.1159/000547615","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giacomo Scherini, Lorenza Magagnoli, Anila Cara, Giulia Boni Brivio, Iacopo Barbetta, Luca Freni, Ulisse Zoni, Diego Curtò, Andrea Stucchi, Matteo Crippa, Mario Cozzolino
{"title":"Association between blood flow measured within 30 days from AV access creation and thrombosis risk.","authors":"Giacomo Scherini, Lorenza Magagnoli, Anila Cara, Giulia Boni Brivio, Iacopo Barbetta, Luca Freni, Ulisse Zoni, Diego Curtò, Andrea Stucchi, Matteo Crippa, Mario Cozzolino","doi":"10.1159/000547480","DOIUrl":"https://doi.org/10.1159/000547480","url":null,"abstract":"<p><strong>Introduction: </strong>Arteriovenous (AV) hemodialysis accesses are hampered by the risk of thrombosis. Due to lack of evidence, current guidelines do not suggest routine assessment of AV access blood flow (Qa) for surveillance. This study aims to analyze the association between post-operative Qa and thrombosis risk, in distal and proximal autologous AV fistulae (dAVF, and pAVF), and AV grafts (AVG).</p><p><strong>Methods: </strong>This retrospective cohort study included all AV accesses created in San Paolo Hospital (Milan, IT) between 2013 and 2022, with a post-operative Qa measurement available within 30 days from creation. Thrombosis-free survival curves were plotted using the Kaplan-Meier method. The association between Qa and thrombosis risk was studied by multivariate Cox proportional hazard models. Non-linearity was assessed using natural splines.</p><p><strong>Results: </strong>A total of 218 AV accesses (92 dAVF, 76 pAVF, and 50 AVG) were created in 191 patients. During a median follow-up time of 1.35 years, 66 AV access thrombosis occurred. In dAVF, Qa showed a significant non-linear association with thrombosis risk, with nadir at Qa of 1289 ml/min and an exponential risk increase for Qa <800 ml/min. In dAVF with a Qa<1289 ml/min, there was a 43% increase in the risk of thrombosis every 100 ml/min decrease in Qa (aHR 1.43 [1.11-1.83], p 0.005). In pAVF and AVG, Qa was not associated with thrombosis risk.</p><p><strong>Conclusion: </strong>Post-operative Qa shows a non-linear association with thrombosis risk in dAVF, suggesting that this may be a useful tool to identify high-risk dAVF allowing closer surveillance or preventive interventions.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-16"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lin Zhang, Li Wang, Xiaotian Jiang, Xiaoxiao Yang, Xiaofang Yu, Jun Ji, Wuhua Jiang, Xiaoqiang Ding
{"title":"Elevated Monocyte-to-Lymphocyte Ratio at Peritoneal Dialysis Initiation Predicts Long-Term Peritonitis Risk: A Retrospective Cohort Study.","authors":"Lin Zhang, Li Wang, Xiaotian Jiang, Xiaoxiao Yang, Xiaofang Yu, Jun Ji, Wuhua Jiang, Xiaoqiang Ding","doi":"10.1159/000547399","DOIUrl":"https://doi.org/10.1159/000547399","url":null,"abstract":"<p><p>Introduction Peritoneal dialysis-associated peritonitis is a major complication in peritoneal dialysis (PD) patients, leading to increased morbidity and technique failure. Identifying reliable biomarkers for predicting peritonitis risk is crucial for early intervention. Monocyte-to-lymphocyte ratio (MLR) is an emerging inflammatory marker associated with adverse outcomes in end-stage renal disease, but its predictive value for peritonitis remains unclear. Methods This retrospective cohort study included PD patients from a single center who had undergone PD for at least three months. MLR was assessed at the time of PD catheter insertion, and patients were followed for 36 months. Peritonitis was defined according to the International Society for Peritoneal Dialysis criteria. Cox proportional hazards models were used to analyze the association between MLR (continuous and tertile-based) and peritonitis, adjusting for demographic, clinical, and laboratory factors. Restricted cubic spline regression was applied to evaluate nonlinearity, and subgroup analysis was conducted to examine whether the association between MLR and peritonitis was consistent across different subgroups. Results A total of 108 patients were included, with 33 (30.6%) developing peritonitis. MLR was significantly higher in the peritonitis group (p = 0.032). Cox regression showed that higher MLR was independently associated with an increased risk of peritonitis (adjusted HR = 1.85, 95% CI: 1.01-3.40, p = 0.047). Patients in the highest MLR tertile had a fivefold increased peritonitis risk compared to those in the lowest tertile (p for trend = 0.004). RCS analysis revealed a nonlinear association, with a threshold at LnMLR = -0.9. Subgroup analysis suggested a stronger association in patients with lower BMI (<24 kg/m²). Conclusion Higher MLR at PD initiation is an independent predictor of long-term peritonitis risk. MLR may serve as a simple, cost-effective biomarker for early peritonitis risk stratification, particularly in leaner patients. Keywords: Peritoneal dialysis, Peritoneal dialysis-associated peritonitis, Monocyte-to-lymphocyte ratio, Inflammation biomarkers.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-18"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of physical function in hemodialysis patients treated with medium cut-off dialyzers, high flux dialyzers, and hemodiafiltration.","authors":"Gizem Kumru, Busra Haktaniyan, Kenan Ates, Sehsuvar Erturk, Gokhan Nergizoglu, Kenan Keven, Sule Sengul, Sim Kutlay","doi":"10.1159/000546941","DOIUrl":"https://doi.org/10.1159/000546941","url":null,"abstract":"<p><strong>Introduction: </strong>All dialysis modalities can potentially improve physical activity levels and patient well-being, primarily through better toxin clearance. We sought to assess the impact of medium cut-off hemodialysis (MCO-HD), high flux hemodialysis (HF-HD), and high-flux hemodiafiltration (HF-HDF) on quantitive physical performance measures, which are prognostic for quality of life and mortality risk.</p><p><strong>Methods: </strong>Ten maintanence hemodialysis patients received MCO-HD, HF-HD, and HF-HDF, each for a duration of six months. Outcomes encompassed alterations in physical activity levels, assessed with the International Physical Activity Questionnaire, and physical performance, evaluated through the 5-times sit-to-stand, 4-meter gait speed, grip strength tests and bioelectrical impedance analysis.</p><p><strong>Results: </strong>The cohort comprised seven men and three women with a median dialysis vintage of 96 months (IQR:36). Dialysis adequacy (single pool KtV≥1.2) was attained across all modalities for 18 months, with no notable alterations in nutritional and inflammation markers, including serum albumin. Self-reported physical activity improved during MCO-HD [Total MET min/week 234.5(IQR:1188) vs 1229.5(IQR:1683), p=0.019]. There were no significant changes in handgrip strength, gait speed, or muscle mass in either group, nor were there any notable differences between the groups. The 5-times sit-to-stand test shown stablility in the MCO-HD group, whereas a substantial enhancement over 6 months observed with the HF-HDF [12.34(IQR:3.88) vs 10.18(IQR:3.14) seconds, p=0.022].</p><p><strong>Conclusion: </strong>The MCO-HD group reported elevated physical activity levels, while the HF-HDF group demonstrated considerable enhancement in low extremity strength. The patient-centered selection of dialysis modality, including the implementation of exercises and nutritional interventions, may improve physical performance and patient outcomes.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-16"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna Lorenzin, Natascha Perin, Massimo de Cal, Monica Zanella, Claudio Ronco
{"title":"Endotoxin and cytokine removal with a new (CA) sorbent cartridge.","authors":"Anna Lorenzin, Natascha Perin, Massimo de Cal, Monica Zanella, Claudio Ronco","doi":"10.1159/000547419","DOIUrl":"https://doi.org/10.1159/000547419","url":null,"abstract":"<p><strong>Introduction: </strong>Endotoxin, also referred to as lipopolysaccharide (LPS), is a major stimulus of the inflammatory response capable of leading to sepsis and septic shock. Extracorporeal blood purification therapies are increasingly employed in the treatment of sepsis. Timely and thorough removal of endotoxin and cytokines can help to mitigate the inflammatory cascade during septic shock. Hemoadsorption (HA) is a promising approach to achieve this goal. In this study, we analyzed different prototypes of a new CA cartridge: we performed in vitro circulations to define endotoxin and cytokine removal capacity.</p><p><strong>Methods: </strong>In vitro HA was performed using GALILEO testing platform, customized circuits with mini-modules of CA cartridge were prepared. A batch of 500 mL of blood pre-conditioned with LPS was utilized for each circulation. We collected samples at different time points: endotoxin activity and removal ratio (RR) of LPS, Interleukin 6 (IL-6) and Interleukin-1 beta (IL-1β) were assessed.</p><p><strong>Results: </strong>The prototypes showed different performances, highlighting promising adsorption affinity towards the target molecules. A potentially clinically meaningful reduction of endotoxin activity by CA mini-module was observed. Concentration of the LPS, cytokine IL-6 and IL-1β showed a significant reduction over time, as confirmed by the RRs.</p><p><strong>Conclusion: </strong>Our experiments allowed to characterize the prototypes in terms of adsorption capacity for both endotoxin and. After this preliminary approach, the final CA mini-module was tested under the same experimental conditions and displayed excellent adsorption capacity, indicating its potential application for endotoxin removal.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-24"},"PeriodicalIF":2.2,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The use of hemoadsorption in cancer-related complications.","authors":"Vedran Premuzic, Lui G Forni","doi":"10.1159/000547348","DOIUrl":"https://doi.org/10.1159/000547348","url":null,"abstract":"<p><p>Ninety percent of all cancer deaths are due to metastatic disease. The majority of patients with metastatic disease are treated with systemic agents and/or radiotherapy, which can provide substantial benefit for many patients, prolong survival and improve symptoms. Patients with metastatic cancer are at risk for drug-related toxicity or disease-related complications leading to development of organ failure such as: rhabdomyolysis-associated AKI, liver failure and multi-organ failure often precipitated by endotoxinemia and sepsis. In cases of systemic hyperinflammatory response, mediated by cytokines, to specific treatment with CAR-T cell therapy or in sepsis with or without development of AKI we do not have an effective and specific target molecule oriented therapy. The predicted survival for cancer patients who develop secondary bacterial infection is decreased and it is only treated by the excessive use of antibiotics with the increased antibiotic resistance. Over the past few decades, numerous experimental and clinical studies have investigated the efficacy of extracorporeal blood purification technologies in the treatment of specific indications like in sepsis and septic shock. Thus far, these therapies have failed to demonstrate an improvement in survival when evaluated in randomized trials. In this review article, our goal is to show the possibility of using different hemoadsorbers in specific indications in patients with cancer-related complications, their reported effectiveness in certain indications listed in the text, and the possibility of applying it in cancer patients not only as a last-stand therapy but as well as preventing development of specific organ or multi-organ failure.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-17"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patricia Muñoz Ramos, Laura Guasch, David Conejo, Esther Rodríguez, Virginia López, Borja Quiroga, Rafael Lucena, Marta Puerta, Mayra Ortega, Laura Medina, Fabio Luca Procaccini, Juan Martín-Navarro, Roberto Alcázar, Patricia de Sequera
{"title":"Influence of different hemodialysis biocontrols on the achievement of the convective volume.","authors":"Patricia Muñoz Ramos, Laura Guasch, David Conejo, Esther Rodríguez, Virginia López, Borja Quiroga, Rafael Lucena, Marta Puerta, Mayra Ortega, Laura Medina, Fabio Luca Procaccini, Juan Martín-Navarro, Roberto Alcázar, Patricia de Sequera","doi":"10.1159/000546642","DOIUrl":"https://doi.org/10.1159/000546642","url":null,"abstract":"<p><strong>Introduction: </strong>Post-dilution on-line hemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality in hemodialysis (HD) patients when high substitution volumes are achieved. To date, little emphasis has been placed on the impact of different biocontrols in achieving high replacement volumes. The aim of the present study is to compare the substitution volume achieved with three different monitors using the three available automatic systems.</p><p><strong>Methods: </strong>Prospective, observational cross-over study of prevalent patients on post-dilution OL-HDF. Each patient underwent 9 consecutive post-dilution OL-HDF sessions with each of the monitors included in the study: Artis, 6008 and Surdial X with the corresponding biocontrol: UltraControl, AutoSub+ and Max-Sub respectively. After each session, the final convective volume and other parameters related to HD and medium-molecule clearance were collected.</p><p><strong>Results: </strong>Thirteen patients were included (57% male, age 62±14 years), of whom 71% were dialysed via an arteriovenous fistula (AVF). The mean time on dialysis was 51±32 months. Convective volume achieved with Max-Sub biocontrol (Surdial X monitor) was higher than that achieved with UltraControl biocontrol (Artis monitor) (29.1±2.1 vs 27.2±2.1 L/session, p=0.006) and AutoSub+ biocontrol (6008 monitor) (29.1±2.1 vs 27±3 L/session, p=0.01). On multivariate analysis, factors associated with higher convective volume were the prescription of Max-Sub biocontrol (B 1.61, 95% CI [0.41-2.80], p=0.009), TPM (B 0.02, 95% CI [0.01-0.03], p=0.018), blood processed (B 0.17, 95% CI [0.08-0.26], p<0.001) and not having diabetes mellitus (B -1.66 95% CI [-2.72-0.59], p=0.002) Conclusion. The volume achieved by convective transport can vary according to the type of biocontrol, with Max-Sub performing the best out of the 3 biocontrol systems.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}