Blood Purification最新文献

{"title":"Are Your Kidneys Ok? Detect early to protect kidney health Running title: Are Your Kidneys Ok?","authors":"Joseph A Vassalotti, Anna Francis, Augusto Cesar Soares Dos Santos, Ricardo Correa-Rotter, Dina Abdellatif, Li-Li Hsiao, Stefanos Roumeliotis, Agnes Haris, Latha A Kumaraswami, Siu-Fai Lui, Alessandro Balducci, Vassilios Liakopoulos","doi":"10.1159/000546512","DOIUrl":"https://doi.org/10.1159/000546512","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-18"},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172423","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":"Innovative solution for treating hypervolemia in patients with End-Stage Renal Disease.","authors":"Abdelaziz Sidi Baba, Hasnae Zahim, Rim El Azrak, Abdellah Boualam, Abdellah Ait Taleb, Benyounès Ramdani, Mohamed Zamd","doi":"10.1159/000545121","DOIUrl":"https://doi.org/10.1159/000545121","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload (FO) is a prevalent and serious complication of end-stage chronic kidney disease (ESRD). Its most dramatic manifestation is acute and life-threatening pulmonary oedema. It is also associated with a high rate of morbidity and mortality in these patients. On the other hand, maintaining a state of hydration and optimal volume in these patients remains the major challenge of renal replacement therapies. We report an emerging technological approach to achieve \"fluid neutrality\" in patients with ESRD. It is a portable and intelligent ultrafiltration device called MorWAK (Moroccan Wearable Artificial Kidney). It was designed to detect, quantify, and treat, daily, fluid overload using the principle of ultrafiltration through a semi-permeable membrane. Its operating principle is based on the use of accordion-shaped suction bellows, already used in surgery, as an ultrafiltration pump. The two aims of this study were to explore the functioning of the suction bellows (establishment of a mathematical equation) and to test the performance of MorWAK in vitro using bovine whole blood.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-25"},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172425","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":"Chloride mass transfers during continuous veno-venous hemodialysis with regional citrate anticoagulation: effects of additional ultrafiltration and Hamburger's effect.","authors":"Matthieu Chivot, Rinaldo Bellomo, Guillaume Deniel, Jean-Christophe Richard, Laurent Bitker","doi":"10.1159/000546322","DOIUrl":"https://doi.org/10.1159/000546322","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysate-to-patient chloride mass transfer may occur during continuous veno-venous hemodialysis (CVVHD) with regional citrate anticoagulation (RCA). However, additional RCA-related ultrafiltration (UFRCA) and plasma chloride shifts to the intracellular compartment may impact mass transfer evaluation to an unknown extent.</p><p><strong>Methods: </strong>In an ancillary prospective, single-center study, we evaluated chloride mass transfer J_(S,Cl) of adult patients treated with CVVHD-RCA. Chloride concentrations were measured in the effluent, and at filter's inlet and outlet on the plasma side. J_(S,Cl) was computed as the difference in chloride mass at the filter's inlet and outlet in each compartment (i.e. dialysate and plasma water). A positive J_(S,Cl) indicated chloride mass removal from plasma water. We accounted for the additional ultrafiltration volume performed automatically by the CVVHD monitor to account for citrate and CaCl2 administered volumes. Dialysate J_(S,Cl) from the CLODICUS study (NCT04755491) were recomputed using this methodology.</p><p><strong>Results: </strong>We studied 10 patients with 18 observations. Dialysate J_(S,Cl) was significantly lower than plasma J_(S,Cl) (0.21 [0.07-0.24] vs. 0.31 [0.15-0.46] mmol.min-1, P<0.05), indicative of chloride removal from plasma water not exclusively related to loss in the dialysate compartment. Chloride removal from plasma was significantly associated with greater decreases in plasma bicarbonate along the filter (P<0.01). In the original CLODICUS study, UFRCA flow amounted to 207 [interquartile range: 172-217] ml.h-1, and the dialysate J_(S,Cl) to 0.11 [-0.01 to 0.23] mmol.min-1. Increasing net ultrafiltration flow was associated with increasing dialysate J_(S,Cl).</p><p><strong>Conclusions: </strong>Plasma chloride mass removal during CVVHD-RCA is significantly greater than what is accounted for by dialysate-based loss, suggesting that plasma chloride is transferred to an intracellular compartment. Furthermore, to account for the online administration of citrate and CaCl2 solutions, CVVHD-RCA applies additional ultrafiltration, which significantly contributes to chloride removal from plasma water.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-18"},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172424","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":"Endotoxin: a bona fide treatable sepsis endotype?","authors":"Hernando Gómez","doi":"10.1159/000546294","DOIUrl":"https://doi.org/10.1159/000546294","url":null,"abstract":"<p><strong>Background: </strong>The recognition of syndromes has been a pillar of medical education and knowledge. However, treatment of syndromes is challenging because there is a disconnect between the underlying mechanisms that lead to organ injury and the clinical expression of this injury. This is an important barrier to identifying effective treatments in sepsis which may be resolved by the identification of sepsis endotypes.</p><p><strong>Summary: </strong>In this review we discuss the rationale for considering endotoxic septic shock as a true endotype, the mechanisms by which endotoxin induces cell and organ injury and dysfunction, the strategies to recognize when it occurs and the potential treatments, focusing on endotoxin removal through extracorporeal blood purification.</p><p><strong>Key messages: </strong>There is sufficient preclinical and clinical evidence to support the notion that endotoxin is a relevant mechanism of injury in human sepsis that drives poor patient outcomes, that can be identified using clinical criteria and biomarkers and that may respond to specific targeted therapies, strongly suggesting that endotoxemic septic shock is a bona fide endotype.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-19"},"PeriodicalIF":2.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075647","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 hemoperfusion in severe COVID-19 patients: A systematic review and meta-analysis.","authors":"Song Shang, Bin Zhang, Baofa Wu, Yaping Dou, Lihai Zhang, Wuzhuang Sun","doi":"10.1159/000546256","DOIUrl":"https://doi.org/10.1159/000546256","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to conduct a meta analysis and systematic review to assess the efficacy of the hemoperfusion in patients with severe COVID-19.</p><p><strong>Data sources: </strong>A comprehensive search for candidate publications was performed using PubMed, Cochrane Library, and Embase.</p><p><strong>Study selections: </strong>Studies investigating the effect of hemoperfusion on mortality among severe COVID-19 patients were selected, including randomized controlled trials(RCTs), non-randomized controlled trials, and observational studies with control groups. The primary endpoint was the longest reported mortality, while the secondary endpoints were the length of stay, ICU stay, P/F ratio, and CRP.</p><p><strong>Data extraction: </strong>The Cochrane test (Q) and Isquare (I2) test were used to quantify heterogeneity among the studies. The fixedeffect model (Mantel-Haenszel method) would be selected when there is no heterogeneity (P > 0.10 and I2 < 50%), whereas the randomeffect model (DerSimonian-Laird method) was used in obvious heterogeneity (P ≤ 0.10 and I2 ≥ 50%). Data are presented as risk ratio(RR); 95% confidence intervals(CIs); p values; I2.</p><p><strong>Data synthesis: </strong>Of the 127 articles retrieved, 14 were selected for this study including 405 patients in the HP group and 518 patients in the control group. There was no statistically significant difference in mortality between the hemoperfusion and the control groups (RR 0.81 95%CI[0.71, 0.93]; p = 0.15 > 0.05; I2 = 68.2%). The results of the subgroup analysis of hemoperfusion with HA series indicated a reduction in the mortality of patients with COVID-19 (RR 0.60 [0.46, 0.78]; p < 0.0001; I2 =0.0%). The hemoperfusion (HP) group had a longer length of stay compared with the control group (WMD 5.25[2.53, 7.97]days; p < 0.05; I2 = 28.0%), but not the ICU stay (ES 1.33[-2.86, 5.53]days; p = 0.53; I2 = 85.5%). After hemoperfusion, the P/F ratio (WMD 95.79[74.46, 117.12]mmHg; p < 0.05; I2 = 5.8%) increased, while CRP (WMD -44.03[-68.97, -19.09]mg/L; p < 0.05; I2 = 86.9%) decreased.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-33"},"PeriodicalIF":2.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075707","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":"Hemoadosorption in pediatric critical care: current insights and future perspectives.","authors":"Gabriella Bottari, Isabella Guzzo, Akash Deep","doi":"10.1159/000546240","DOIUrl":"https://doi.org/10.1159/000546240","url":null,"abstract":"<p><strong>Background: </strong>Hemoadsorption (HA) is increasingly recognized as a valuable extracorporeal blood purification technique in paediatric intensive care. Although initially developed for adult patients, HA's application in paediatric critical care, particularly for conditions such as septic shock, liver failure, and rhabdomyolysis, has gained significant attention due to promising clinical outcomes.</p><p><strong>Summary: </strong>HA has demonstrated efficacy in managing paediatric septic shock by reducing vasopressor requirements and lowering inflammatory markers. In liver failure, HA complements continuous renal replacement therapy (CRRT) by removing albumin-bound toxins and cytokines, mitigating systemic inflammation. Emerging evidence also supports HA as a rescue therapy in rare paediatric conditions like rhabdomyolysis and acute intoxications, preventing organ damage and reducing morbidity. Despite its benefits, HA in paediatrics presents technical challenges, including concerns over extracorporeal circuit volumes, vascular access, and anticoagulation. Paediatric-specific devices, such as the HA60, BS80 and PMX-05R, are addressing these limitations by offering lower priming volumes suitable for small children. Recent studies have highlighted improvements in hemodynamic stability, cytokine reduction, and organ function, reinforcing HA's potential as a critical adjuvant therapy. This review underscores the evolving landscape of HA in paediatric critical care, advocating for further research to optimize its application across diverse clinical scenarios.</p><p><strong>Key messages: </strong>• HA shows significant promise in paediatric septic shock, liver failure, and rhabdomyolysis. • Technical advancements are expanding HA's applicability to neonates and small infants. • More multicentre studies are needed to establish HA's role in reducing mortality and improving quality of life post-PICU.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-15"},"PeriodicalIF":2.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075669","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":"Perspectives on Water Utilization in Hemodialysis: Nephrologists' Responsibilities.","authors":"Rahul Abraham, David S Goldfarb","doi":"10.1159/000546034","DOIUrl":"https://doi.org/10.1159/000546034","url":null,"abstract":"<p><strong>Background: </strong>Hemodialysis is a water-intense procedure, needing large quantities of water for preparation of small volumes of dialysate. The resulting large volumes of reject water is usually discarded. With the rising water crisis both in the United States and the world, it is essential to understand water utilization and identify ways to minimize its utilization and maximize the use of the reject water.</p><p><strong>Summary: </strong>Unfortunately, water from the city sources cannot be used to produce dialysate unless it undergoes further purification. This results in a large amount of reject water, which can be from 50-70% of total water use, resulting in an enormous waste of resources. A review of solutions for water sustainability is broadly classified into solutions that decrease water utilization and solutions for increased reject water utilization. Those that are aimed at decreasing water utilization were mainly based in innovations in technology - examples are NxStage PureFlow™SL, Aquaboss by Braun and AquaBPlus by Fresenius, and those that focused on increased reuse of RO reject water rely on data that it can be safely utilized for various purposes such as irrigation and flushing toilets. These strategies can be cost-effective. Although the need for sustainability has been recognized there needs to be further awareness and participation among nephrologists to further this cause. In addition, there need to be policies put forward by the government that could encourage sustainability.</p><p><strong>Key messages: </strong>Hemodialysis continues to heavily tax the environment. Although the need for sustainability has been recognized, there still remains a lot of work that needs to be done. Further buy-in is needed from all participating entities - nephrologists, dialysis manufacturers and organizations and the government in order to safeguard our limited resources.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-16"},"PeriodicalIF":2.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960974","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":"Impact of No Anticoagulation, Citrate Anticoagulation, and Heparin Anticoagulation on CRRT Outcomes in Patients with Hyperlactatemia: A Retrospective Cohort Study.","authors":"Yaxin Xiong, Xiqing Luo, Jianpeng Wang, Quankuan Gu, Jiuyue Sun, Ze Meng, Shuang Tang, Jun Lyu, Mingyan Zhao, Xianglin Meng","doi":"10.1159/000546195","DOIUrl":"https://doi.org/10.1159/000546195","url":null,"abstract":"<p><p>Introduction Continuous renal replacement therapy (CRRT) is one of the most critical interventions in the intensive care unit (ICU), and anticoagulation is essential to ensure its efficacy. Regional citrate anticoagulation (RCA) has been widely adopted in clinical practice due to its reduced risk of bleeding complications. However, the suitability of RCA for CRRT in patients with hyperlactatemia remains controversial. Methods This study aimed to evaluate the efficacy and safety of different anticoagulation strategies (heparin systemic anticoagulation, RCA, and no anticoagulation) during CRRT in critically ill patients with hyperlactatemia. Using a retrospective cohort design, we analyzed clinical data from the MIMIC-IV v3.0 database, employing propensity score matching (PSM) and multivariable Cox regression models to adjust for confounding factors. Results Our findings demonstrated that compared to the no-anticoagulation group, the citrate group exhibited significantly lower 28-day, 60-day, and 90-day mortality risks, with hazard ratios (HRs) of 0.623, 0.650, and 0.657, respectively. In contrast, the heparin group showed a significant reduction only in 28-day mortality risk (HR = 0.625). These results were further validated in the matched cohort, indicating that RCA significantly improves clinical outcomes and reduces mortality in hyperlactatemia patients requiring CRRT. Conclusion In summary, our study indicates that citrate anticoagulation significantly improves the prognosis of CRRT in patients with hyperlactatemia, suggesting its potential as a preferred anticoagulation strategy in this clinical setting.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-19"},"PeriodicalIF":2.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961740","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":"Current Experience Using the Selective Cytopheretic Device for Continuous Immunomodulation in Acute Kidney Injury and Multiorgan Failure.","authors":"Stuart L Goldstein, H David Humes","doi":"10.1159/000546219","DOIUrl":"https://doi.org/10.1159/000546219","url":null,"abstract":"<p><p>Introduction Sepsis and sepsis-associated acute kidney injury (AKI) are associated with increased patient morbidity and mortality. The immediate host response aimed at combating infection can become dysregulated, leading to uncontrolled inflammation and multi-organ failure, including AKI. Therapies targeting one protein component of the sepsis pathway have largely failed to improve patient outcomes, and currently only organ support therapies are used clinically to provide time for innate organ recovery to occur. The Selective Cytopheretic Device (SCD) is a continuous cell processing immunomodulatory device that attracts activated neutrophils and monocytes its biomimetic membrane surface. The activated leukocytes are transformed to a less pro-inflammatory phenotype and released back into the circulation when exposed to low ionized calcium concentration established in the SCD by standard regional citrate anticoagulation protocols used in continuous renal replacement therapy. Review In this review, we detail the history of the SCD and our experience with it, from discovery to pre-clinical testing to translational research application at the bedside. We discuss the SCD mechanism of action, its immunomodulatory effect, and the human studies involving critically ill adult pediatric patients with AKI who require continuous renal replacement therapy as part of the standard of care. We conclude discussing ongoing and future application of the SCD in both acute and chronic inflammatory states that would benefit from immunomodulation.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973815","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":"Diluted Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy in Pediatric Patients: Suggested Practice Points.","authors":"Sidharth Kumar Sethi, Ashita Tolwani, Omer S Ashruf, Mihika Aggarwal, Girish Chandra Bhatt, Aishwarya Nair, Kritika Soni, Savita Savita, Shyam Bihari Bansal, Khalid Alhasan, Timothy Bunchman, Rupesh Raina","doi":"10.1159/000545674","DOIUrl":"https://doi.org/10.1159/000545674","url":null,"abstract":"<p><p>Introduction Continuous renal replacement therapy (CRRT) is increasingly used in critical pediatric patients with acute kidney injury (AKI). The choice of anticoagulant is vital to minimize circuit clotting and bleeding complications. Regional citrate anticoagulation (RCA) is preferred for its safety profile, particularly in critically ill pediatric patients who are susceptible to bleeding. Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and Cochrane databases following PRISMA guidelines. Keywords included 'diluted citrate,' 'regional citrate anticoagulation,' 'continuous renal replacement therapy,' 'pediatrics,' and 'adverse effects.' Studies were included if they involved neonates and pediatric patients, reported citrate concentration, and safety and efficacy outcomes of RCA in CRRT. Data were extracted on study characteristics, citrate concentration, circuit lifespan, metabolic and electrolyte disturbances, and other adverse effects. Results A total of 16 studies met the inclusion criteria. RCA was associated with fewer clotting events and a longer median circuit life compared to heparin. However, complications such as metabolic alkalosis, hypocalcemia, and hypernatremia were noted. In our single-centre experience, dilute citrate anticoagulation was used in 16 pediatric patients undergoing CRRT, showing promising results with reduced clotting and prolonged circuit life. The modified pediatric citrate protocol presented aims to address complications by using a diluted citrate solution. Conclusions RCA is effective in prolonging circuit life and reducing clotting in pediatric CRRT. The modified pediatric citrate protocol presents a safer alternative by reducing the risk of metabolic and electrolyte disturbances. Ongoing monitoring of calcium and electrolyte levels is essential to mitigate potential complications. This protocol may standardize RCA use in pediatric CRRT, improving safety and outcomes for critically ill children with AKI.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-33"},"PeriodicalIF":2.2,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977343","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}