Blood Purification最新文献

{"title":"In vitro Assessment of Drug Adsorption Profiles During Hemoadsorption Therapy.","authors":"Andreas Körtge, Christoph Kamper, Gerd Klinkmann, Reinhold Wasserkort, Steffen Mitzner","doi":"10.1159/000545120","DOIUrl":"https://doi.org/10.1159/000545120","url":null,"abstract":"<p><strong>Introduction: </strong>The use of hemoadsorption devices is increasingly gaining impact as an adjunct therapy for various critical conditions in ICU patients, including systemic hyperinflammation, cytokine release syndrome (CRS), sepsis, and more. A key concern in this therapy is its impact on the plasma levels of concurrently administered drugs, which could potentially be reduced to subtherapeutic levels, affecting patient care. The present study investigates the adsorption behavior of various drugs in an in vitro hemoadsorption model using human whole blood, aiming to provide insights for optimizing drug dosing during hemoadsorption therapy.</p><p><strong>Methods: </strong>The study assessed the removal rates and clearances of several drugs, namely apixaban, argatroban, carbamazepine, oxcarbazepine, lamotrigine, phenytoin, valproate, levosimendan, methylene blue, and metformin, by circulating the blood through CytoSorb adsorbers in an in vitro setup.</p><p><strong>Results: </strong>Significant removal (75 to 100% of the initial concentration) and high initial plasma clearances (approximately 10-25 mL/min) were observed for most of the tested drugs within the first 30-60 minutes of recirculation. Lower removal rates and clearances were noted for valproate (approximately 40% and 5 mL/min) and metformin (approximately 15% and 1 mL/min).</p><p><strong>Conclusion: </strong>The findings indicate considerable differences in the adsorption of the tested drugs and should be confirmed by additional in vivo studies with careful monitoring of drug levels throughout the course of therapy.Understanding the in vivo dynamics is crucial for adjusting dosages appropriately during hemoadsorption use to ensure therapeutic efficacy and patient safety.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-17"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668998","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":"Development and validation of a risk prediction model for citrate accumulation in patients undergoing continuous renal replacement therapy with regional citrate anticoagulation.","authors":"Yi Zheng, Zhiwen Chen, Xiankun Sun, Fang Wang, Xue Tang, Li Lin, Ling Zhang, Yanyan Wang","doi":"10.1159/000545291","DOIUrl":"https://doi.org/10.1159/000545291","url":null,"abstract":"<p><strong>Introduction: </strong>Regional citrate anticoagulation (RCA) is now recommended as the first choice of anticoagulation for continuous renal replacement therapy (CRRT). However, impaired citrate metabolism can lead to citrate accumulation (CA), resulting in severe metabolic acidosis and hypocalcemia, which poses a challenge for clinicians when making decision about the use of RCA.</p><p><strong>Methods: </strong>In this retrospective cohort study performed in West China Hospital of Sichuan University, we evaluated patients who underwent RCA-based CRRT from 2021 to 2023. Participants were randomly allocated into training and validation groups at a 7:3 ratio. In the training group, significant risk factors for CA were determined by a binary logistic regression analysis and established a risk prediction model, the validation group validated and evaluated the model. A nomogram was constructed to visualize the prediction model, and calibration and receiver operating characteristic (ROC) curves were used to evaluate the prediction accuracy, and decision curve analysis (DCA) was used to evaluate the clinical effectiveness.</p><p><strong>Results: </strong>Of the 1,259 patients with RCA-CRRT, 882 were randomly stratified into the training group and 377 into the validation group. CA was reported in 16.2% and 16.7%, respectively. We developed and validated a nomogram to predict the risk of CA, incorporating significant factors including male, age, body surface area (BSA), mean hourly citrate dosage, systolic blood pressure (SBP), lactate, total bilirubin (TBIL) and international normalized ratio (INR). The area under the ROC curve of the nomogram was 0.760 (95% CI, 0.737-0.765) and 0.752 (95% CI, 0.744-0.787) in both groups. The calibration curve further confirmed its effective discrimination and calibration abilities. DCA analysis emphasized its clinical utility when the CA probability threshold for intervention is between 11% and 76%.</p><p><strong>Conclusion: </strong>We developed and validated a useful prediction model for CA in critically ill patients who underwent RCA-CRRT, assisting clinicians in identifying high-risk individuals.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669061","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":"Blueprint for a Catalan Apheresis Database Initiative: The Catalan Apheresis Therapeutics Network and Its Role in Supporting Health Administration Planning.","authors":"Joan Cid, Eva Rodríguez, Sandra Ortega, Anna M Garcia, Jordi Comas, Paola Charry, Miquel Lozano, Rosa Ramos","doi":"10.1159/000545202","DOIUrl":"https://doi.org/10.1159/000545202","url":null,"abstract":"<p><p>The Therapeutic Apheresis Database (AfTerCat) was developed to consolidate and standardize data collection for therapeutic apheresis procedures public and private institutions in Catalonia. It covers procedures performed between 2019 and 2023 in 21 apheresis units, with over 26,000 entries, including plasma treatments, cell therapies, and cytapheresis. Variations in workload across public and private institutions were noted, which affecting resource needs and operational costs. By streamlining manual data collection and planning future automation, the AfTerCat registry aims to provide crucial insights for healthcare administrators in optimizing resource allocation, managing procedure costs, and supporting evidence-based policy decisions. The registry's integration into the Organització Catalana de Trasplantaments' (OCATT) digital transformation initiative highlights its potential to impact health policy through improving data centralization and real-time analysis. This project serves as a foundational step toward efficient health system planning and cost management in the growing field of therapeutic apheresis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669058","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":"Stability and compatibility of amikacin and its combination antibiotics in 7.5% icodextrin peritoneal dialysis solution.","authors":"Haishan Wu, Pengchao Fang, Zhihao Liu, Haiping Mao, Wei Chen, Xiao Yang, Haiyan Hu, Qunying Guo","doi":"10.1159/000545085","DOIUrl":"https://doi.org/10.1159/000545085","url":null,"abstract":"<p><strong>Introduction: </strong>The study aimed to evaluate the stability and compatibility of diverse antibiotics in 7.5% icodextrin peritoneal dialysis (PD) solution, subjected to various temperatures over a span of 14 days period.</p><p><strong>Methods: </strong>Antibiotics, namely amikacin, imipenem, ciprofloxacin, vancomycin and cefazolin, were incorporated into 7.5% icodextrin solution and subsequently stored at various temperature and period. The concentrations of these antibiotics were measured using high-performance liquid chromatography. Stability of antibiotics is defined as the remaining drug concentration > 90% of the initial one throughout the test period.</p><p><strong>Results: </strong>Ciprofloxacin and amikacin were demonstrated stable for a period of 14 days in icodextrin solution across all tested temperatures. Amikacin retained over 90% of its initial concentration when combined with either vancomycin, cefazolin, or ciprofloxacin at various temperatures for 14 days. In combination with amikacin, ciprofloxacin maintained stability for 14 days at all tested temperatures, while vancomycin maintained stability for 14 days at both 4 ℃ and 25℃, and 7 days at 37℃. Cefazolin, however, only exhibited stability for 8 hours at 37°C and 7 days at both 4°C and 25°C. The stability of imipenem in icodextrin solution was notably low, remaining stable for a maximum 6 hours at 4°C.</p><p><strong>Conclusion: </strong>Ciprofloxacin, amikacin, as well as combinations of amikacin and vancomycin, amikacin and cefazolin, amikacin and ciprofloxacin, can be added to icodextrin solution for treatment of peritoneal dialysis associated peritonitis because they maintain stability for a minimum of 7 days at the temperatures of 4℃ and 25℃, and 8 hours at 37℃.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-14"},"PeriodicalIF":2.2,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668669","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":"Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients.","authors":"Eleonora Balzani, Sergio Lassola, Hannah Wozniak, Giacomo Bellani, Silvia De Rosa","doi":"10.1159/000543856","DOIUrl":"10.1159/000543856","url":null,"abstract":"<p><strong>Background: </strong>Polymethyl methacrylate (PMMA) membranes are increasingly recognized for their effectiveness in treating acute kidney injury (AKI) due to their strong adsorption capabilities, particularly for inflammatory mediators like β2-microglobulin and IL-6. These membranes ensure mechanical stability and chemical inertness, minimizing adverse reactions during blood filtration.</p><p><strong>Summary: </strong>In acute conditions such as sepsis and acute respiratory distress syndrome (ARDS), PMMA membranes show promising findings. In sepsis, they may help reduce multiorgan failure by modulating immune responses, although further research is needed to confirm their routine use. For ARDS, PMMA membranes could mitigate \"cytokine storms\" by adsorbing key cytokines, improving oxygenation and hemodynamic stability, which may reduce ICU stays and reliance on mechanical ventilation. Monitoring biomarkers like IL-6, TNF-α is critical for tracking efficacy and tailoring therapy to individual needs. In chronic conditions, such as hemodialysis for chronic kidney disease, PMMA membranes help lower oxidative stress and β2-microglobulin levels, reducing complications such as amyloidosis. By decreasing oxidative damage, they provide long-term protective benefits for dialysis patients.</p><p><strong>Key message: </strong>While these advantages are notable, large-scale studies are needed to establish PMMA's efficacy, refine treatment protocols, and confirm its broader role in acute and chronic disease management. The potential of PMMA membranes highlights their value, but standardized clinical evidence is necessary for widespread adoption.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647176","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":"Reply to: Brozat et al. Albumin and platelet loss during the application of CytoSorb® in critically ill patients: a post-hoc analysis of the Cyto-SOLVE trial.","authors":"Benedetta Savasta, Martina Giacco, Federico Pappalardo","doi":"10.1159/000545179","DOIUrl":"https://doi.org/10.1159/000545179","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-4"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603071","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":"Targeted Rapid Endotoxin Adsorption (TREA): can we bring precision medicine to sepsis?","authors":"John Kellum, Esha Kamaluddin, Debra Foster","doi":"10.1159/000544989","DOIUrl":"https://doi.org/10.1159/000544989","url":null,"abstract":"<p><strong>Background: </strong>Historically, extracorporeal blood purification (EBP) treatment for sepsis was mainly used as an adjunctive therapy for the management of multiple organ failure rather than targeting the removal of toxins from the body that are contributing to the disease state. Approximately 10-15% of sepsis, or approximately one third to half of patients with septic shock, exhibit high levels of endotoxin activity in their blood. Humans are exquisitely sensitive to endotoxin making endotoxic septic shock (ESS) particularly deadly. Today, we have an emerging class of EBP that is specific to endotoxin - Targeted Rapid Endotoxin Adsorption (TREA) - that can be used for the treatment of ESS.</p><p><strong>Summary: </strong>In septic patients, evidence for the use of hemofiltration and therapeutic plasma exchange (TPE), the two most prevalent forms of EBP, has been difficult to obtain. Additionally, broad-spectrum EBP therapies that target multiple solutes for removal have struggled to identify the right patients. There is significant clinical heterogeneity of the innate immune response across patients with sepsis. In contrast, targeted EBP therapies which involve measuring a single solute then choosing appropriate therapy to target its removal, allows for the specific selection of a suitable patient. Unfortunately, measuring the target can prove challenging. Endotoxin can be measured in whole blood using the endotoxin activity assay. However, owing to the size of intact endotoxin molecule, it cannot be filtered using hemofiltration membranes. Adsorption, which only requires the contact of blood or plasma with a sorbent is therefore a suitable model to target its removal. TREA technologies include devices that specifically target endotoxin (Alteco LPS Adsorber, MATISSE Adsorber, Toraymyxin 20-R, Toxipak sorption column) and those for which endotoxin removal is included in a more broad-spectrum device (Efferon LPS, oXiris).</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603415","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":"Hemoadsorption in Critical Care Nephrology.","authors":"Vedran Premuzic, Claudio Ronco","doi":"10.1159/000543875","DOIUrl":"10.1159/000543875","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603128","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":"Removal of Ticagrelor by Hemoadsorption with the HA380 Cartridge.","authors":"Taku Furukawa, Yugeesh R Lankadeva, Ian C Baldwin, Pei Chen Connie Ow, Sally Hood, Youssef Daali, Antoine Schneider, Laurent A Decosterd, Clive N May, Rinaldo Bellomo","doi":"10.1159/000544770","DOIUrl":"10.1159/000544770","url":null,"abstract":"<p><strong>Introduction: </strong>Hemoadsorption has emerged as a potential intervention for the removal of ticagrelor. We aimed to evaluate the efficacy of the HA380 hemoadsorption cartridge for this purpose.</p><p><strong>Methods: </strong>Six healthy adult sheep received 270 mg of ticagrelor via an orogastric tube, followed by hemoadsorption using a HA380 cartridge for a duration of 4 h. The sorbent-based removal ratio, clearance, and mass removal rate were assessed at multiple time points.</p><p><strong>Results: </strong>The HA380 cartridge achieved an initial sorbent-based removal ratio of 48.9% (SD 11.8) at 10 min, which declined rapidly to 2.66% (SD 18.5) at 120 min and 0.48% (SD 17.0) at 240 min. Clearance followed a similar trend, starting at 46.1 mL/min (SD 11.4) and decreasing to 0.08 mL/min (SD 16.8) at 240 min. The mass removal rate also dropped significantly over time, from 3.74 ng/min (SD 2.54) at 10 min to near zero at 120 and 240 min.</p><p><strong>Conclusion: </strong>HA with the HA380 cartridge can achieve an early 50% adsorption level for ticagrelor. If frequently changed, the HA380 cartridge may serve as a potential option for ticagrelor removal, when clinically indicated.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447862","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 Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas.","authors":"Jing Wen, Shen Zhan, Yuzhu Wang, Lihong Zhang, Han Li","doi":"10.1159/000543827","DOIUrl":"10.1159/000543827","url":null,"abstract":"<p><strong>Introduction: </strong>Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block (SNB) during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access.</p><p><strong>Methods: </strong>Two hundred forty-six patients with dysfunctional radiocephalic AVF undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022, to August 31, 2023. The patients were randomized into either the SNB group (SNB group, n = 123) or the local infiltration anesthesia group (LA group, n = 123). A visual analog scale (VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The AVF patency at 1 and 3 months after PTA was also evaluated.</p><p><strong>Results: </strong>Compared with the LA group, the SNB group had significantly lower VAS scores (Z = -7.193, p < 0.001) and required fewer additional anesthetics during the operation (χ2 = -4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the SNB group (p < 0.05). Eight patients in the SNB group encountered grade 3 motor paralysis after the operation, and they all recovered within 60 min. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05).</p><p><strong>Conclusion: </strong>Compared with LA, ultrasound-guided SNB has advantages over the LA during endovascular treatment of dysfunctional hemodialysis (HD) fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in HD patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405317","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}