Blood Purification最新文献

{"title":"Perspective Article: Hyperammonemia without Liver Failure - Key Considerations for Intensivists.","authors":"Priscilla Gillis, Thibault Gennart, Sydney Blackman, Nathan De Lissnyder, Patrick M Honoré","doi":"10.1159/000551474","DOIUrl":"10.1159/000551474","url":null,"abstract":"<p><p>Urea cycle disorders represent the most frequent cause of hyperammonemia in the absence of liver failure and may lead to life-threatening elevations in plasma ammonia, particularly when onset is acute and rapidly progressive. Although the etiologies and management principles of acute liver failure have been extensively addressed elsewhere, hyperammonemia must be recognized in critically ill patients as a potential cause of coma, especially when hepatic failure is not present. Non-hepatic causes, including urea cycle disorders, infectious diseases, drug-induced toxicity, and post-transplant complications, are frequently underrecognized. Management requires prompt neuroprotective measures, short-term protein restriction with appropriate nutritional support, and rapid ammonia removal, preferably using high-dose continuous renal replacement therapy. Early intervention is crucial to prevent cerebral edema and to improve neurological outcomes.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"553-560"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442541","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":"Toward Green Dialysis: Efficacy and Sustainability with Reduced Dialysate Flow in Expanded Hemodialysis.","authors":"Carolina Ramos, Juan Felipe Gutiérrez, Rafael M Sanabria, Jasmin Vesga, Juan Castellanos De la Hoz, Eduardo Zuniga-Rodriguez, Alejandra Molano-Triviño","doi":"10.1159/000548892","DOIUrl":"10.1159/000548892","url":null,"abstract":"<p><p><p>Introduction: Reducing dialysate flow (Qd) to 400 mL/min has proven to be sufficient, safe, and effective in meeting dialysis adequacy requirements in adults, with the added advantage of decreasing water consumption per dialysis session. Expanded hemodialysis (HDx), which uses dialyzers with membranes capable of enhanced clearance of medium-sized molecules due to expanded pore capacity, has higher efficiency and reduces the importance of the dialysate-to-blood flow ratio (Qd/Qb) for molecule removal. The objective of this study was to evaluate dialysis effectiveness by analyzing the reduction rate of medium-sized molecules in patients weighing ≤70 kg, comparing Qd 400 mL/min vs. 500 mL/min in HDx using Theranova® membrane.</p><p><strong>Methods: </strong>A post hoc analysis of the COREXH study population was performed. This observational, analytical, retrospective cohort study included 23 patients, of whom 11 (47%) had Qd 400 mL/min and 12 (52.1%) had Qd 500 mL/min.</p><p><strong>Results: </strong>No statistically significant differences were observed in the reduction rate of medium-sized molecules between the Qd 400 mL/min and 500 mL/min groups. Additionally, water consumption was lower in the Qd 400 mL/min group, with an average saving of 24 L per patient per session and 13,824 L over 12 weeks.</p><p><strong>Conclusion: </strong>Using Qd 400 mL/min in HDx vs. 500 mL/min did not affect dialysis effectiveness in terms of molecule reduction rates and resulted in substantial water savings in Qd 400 mL/min group. </p>.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"148-155"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145407965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Antithrombin III Activity, Nafamostat Monotherapy without Heparin, and Small Filter Size Are Associated with a Shorter Circuit Lifespan in Pediatric Continuous Kidney Replacement Therapy: A Single-Center Retrospective Cohort Study.","authors":"Kentaro Ide, Yusuke Tokuda, Junichiro Morota, Eisaku Nashiki, Kentaro Nishi, Mai Miyaji, Masamichi Shibata, Shotaro Matsumoto","doi":"10.1159/000549060","DOIUrl":"10.1159/000549060","url":null,"abstract":"<p><strong>Introduction: </strong>Premature circuit clotting remains a major limitation of pediatric continuous kidney replacement therapy (CKRT). While anticoagulation with heparin or citrate has been well studied, the risk factors for circuit failure under nafamostat mesylate (NM) use have not been well characterized.</p><p><strong>Methods: </strong>This retrospective cohort study included pediatric patients aged <16 years who underwent CKRT in a single tertiary care center in Japan. Circuits that were discontinued within 48 h due to clotting were defined as those with a shorter circuit lifespan. Patient demographics, laboratory parameters, and CKRT settings were compared between the circuits with short and long lifespans. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for a short circuit lifespan, and Kaplan-Meier analysis was employed to assess circuit survival over time.</p><p><strong>Results: </strong>After excluding circuits associated with extracorporeal membrane oxygenation or elective discontinuation within 48 h, the final analysis comprised 162 CKRT circuits, including 52 circuits (32%) with a short lifespan. By multivariate analysis, low antithrombin III (ATIII) activity before CKRT initiation (odds ratio [OR] 0.97, 95% confidence interval [CI]: 0.95-0.99), NM monotherapy without heparin (OR 0.23, 95% CI: 0.059-0.88), and small filter size (OR: 0.23, 95% CI: 0.077-0.67) were independently associated with a short circuit lifespan. By Kaplan-Meier analysis, circuit survival was significantly longer in patients with an ATIII activity of ≥59% and in those treated with heparin.</p><p><strong>Conclusions: </strong>Low ATIII activity, NM monotherapy without heparin, and small filter size were independent risk factors for a shorter circuit lifespan in pediatric CKRT.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"114-122"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318026","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: Can We Bring Precision Medicine to Sepsis?","authors":"John A Kellum, Esha Kamaluddin, Debra Foster","doi":"10.1159/000544989","DOIUrl":"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 cases, 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, 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, allow 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 20R, Toxipak sorption column) and those for which endotoxin removal is included in a more broad-spectrum device (Efferon LPS, oXiris).</p><p><strong>Key messages: </strong>While only a small number of devices are currently available in the TREA class of EBP, there is an opportunity here to bring precision medicine to sepsis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"354-365"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","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":"Drug Removal by Hemoadsorption.","authors":"Ilona Lemagnen, Céline Monard, Maxime Palluau, Layla Bergamaschi, Taku Furukawa, Rinaldo Bellomo, Antoine Schneider","doi":"10.1159/000545804","DOIUrl":"10.1159/000545804","url":null,"abstract":"<p><strong>Background: </strong>There is growing interest in hemoadsorption (HA) therapies in critically ill patients although their precise indications remain to be established. Several devices are available on the market with heterogeneous properties and capabilities.</p><p><strong>Summary: </strong>Due to the nonspecific removal associated with most HA techniques, concerns have been raised on their unintended removal of drugs such as anti-infectives in sepsis. On the other hand, drug removal might be beneficial in certain situations for instance antithrombotic medications in patients requiring emergency surgery or in case of accidental or self-induced intoxication. In this review, we summarize available in vitro, in vivo, and clinical studies reporting on the influence of various HA techniques on drugs pharmacokinetics.</p><p><strong>Key message: </strong>We conclude that further studies should aim at providing drug dosing recommendations during HA and confirm its safety, efficacy, and practicalities when used for intoxications.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"366-378"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961054","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 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":"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 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, and customized circuits with mini-modules of CA cartridge were prepared. A batch of 500 mL of blood preconditioned 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 toward the target molecules. A potentially clinically meaningful reduction of endotoxin activity by CA mini-module was observed. Concentration of the LPS, and cytokines 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 cytokines. 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":"464-472"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","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":"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":"329-330"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","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":"Erratum.","authors":"","doi":"10.1159/000552410","DOIUrl":"10.1159/000552410","url":null,"abstract":"<p><p>In the article \"Extracorporeal Blood Purification with the oXiris® Filter for Patients with Sepsis and Hyperinflammatory Conditions: The Asia-Pacific oXiris Expert Meeting 2024 Consensus Statements\" [Blood Purif. 2025;54(11):621-638; https://doi.org/10.1159/000548214] by Zhang et al., the authors noticed there was an error in Figure 1.Fig. 1.Treatment algorithm for oXiris filter use in patients needing CRRT with sepsis/septic shock, severe COVID-19 or other hyperinflammatory states. AKI, acute kidney injury; APACHE, Acute Physiology and Chronic Health Evaluation; CRP, C-reactive protein; CRRT, continuous renal replacement therapy; CVVH, continuous veno-venous hemofiltration; CVVHD, continuous veno-venous hemodialysis; CVVHDF, continuous veno-venous hemodiafiltration; EAA, endotoxin activity assay; ECMO, extracorporeal membrane oxygenation; HIT, heparin-induced thrombocytopenia; SOFA, Sequential Organ Failure Assessment; KDIGO, Kidney Disease: Improving Global Outcomes; PCT, procalcitonin; IL, interleukin; PaO2/FiO2, partial pressure-to-fractional inspired oxygen ratio; SCUF, slow continuous ultrafiltration; TNF, tumor necrosis factor.In the \"Failure\" column of the \"Evaluate treatment success/failure\" section, the figure originally stated: \"Improvement in hemodynamic parameters/dependence on vasopressors after 72 hours.\" The word \"No\" was inadvertently omitted at the beginning of this criterion. The correct statement should read: \"No improvement in hemodynamic parameters/dependence on vasopressors after 72 hours.\"The error was introduced during the preparation of the figure. The correct wording has been verified by cross-referencing the figure with Statement 5.1 in the main text (p. 630) and Table 1 (p. 625), both of which consistently and correctly state the treatment futility criterion as: \"No improvement in hemodynamic parameters/dependence on vasopressors after 72 hours.\" The corrected Figure 1 is shown below.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"650-652"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700750","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":"Lights and Shadows of Surviving Sepsis Campaign Recommendations.","authors":"Claudio Ronco, Vedran Premuzic","doi":"10.1159/000553535","DOIUrl":"10.1159/000553535","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"565-568"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468572","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":"Exploring the Impact of Expanded Hemodialysis with Super-High-Flux Dialyzer on Inflammation and Gene Expression: A Prospective Cohort Study in Prevalent Hemodialysis Patients.","authors":"Theerachai Thammathiwat, Tantip Arigul, Thidathip Wongsurawat, Piroon Jenjaroenpun, Prapat Suriyaphol, Watchara Pichitsiri, Supinda Sirilak, Noppakao Kongtal, Suri Tangchitthavorngul, Parttarawee Damee, Pajaree Chariyavilaskul, Jira Jongcharoenkamol, Anuchit Phanumartwiwath, Kullaya Takkavatakarn, Paweena Susantitaphong, Somchai Eiam-Ong, Sutatip Pongcharoen, Khajohn Tiranathanagul","doi":"10.1159/000551822","DOIUrl":"10.1159/000551822","url":null,"abstract":"<p><strong>Introduction: </strong>End-stage kidney disease (ESKD) features chronic inflammation and immune dysregulation. The effects of long-term expanded hemodialysis (HDx) using a super-high-flux (SHF) dialyzer on peripheral blood mononuclear cell (PBMC) transcriptomes and circulating inflammatory markers are unclear.</p><p><strong>Methods: </strong>In a single-center pilot study, 10 prevalent hemodialysis patients were evaluated at baseline on standard high-flux hemodialysis and after 12 months on high-efficiency HDx delivered with an SHF dialyzer (ELISIO-17Hx; Nipro, Osaka, Japan). PBMC RNA sequencing was performed by Macrogen (Seoul, South Korea). Serum cytokines/chemokines were quantified by bead-based multiplex immunoassay on the Luminex xMAP platform (MILLIPLEX; Merck, Darmstadt, Germany). Differential expression controlled the false-discovery rate; paired tests compared biomarker levels.</p><p><strong>Results: </strong>Out of 43 genes analyzed, 12 showed significant upregulation. TNF and CCL4 genes were notably altered after 12 months of HDx (adjusted p = 0.037 and p = 0.025). Serum levels of pro-inflammatory markers - TNF-α, CCL4, CCL2, and MMP-9 - significantly declined, while IL-10 increased (p < 0.001). Specific changes included TNF-α (31.5 [29.2-35.2] to 26.9 [23.7-30.9] pg/mL; p = 0.028), CCL4 (32.5 ± 14.1 to 22.7 ± 8.2 pg/mL; p = 0.015), CCL2 (489.6 ± 97.0 to 319.6 ± 103.5 pg/mL; p < 0.001), and MMP-9 (5,241.5 [4,432.3-19,709.3] to 555.6 [202.0-709.3] pg/mL; p = 0.005). IL-10 increased from 2.80 ± 1.86 to 5.15 ± 2.10 pg/mL (p = 0.001). TNF-β showed a nonsignificant change (mean difference -2.4; p = 0.101). Other markers remained unchanged.</p><p><strong>Conclusion: </strong>ESKD shows PBMC upregulation of TNF and CCL4, whereas 12-month high-efficiency HDx lowers circulating TNF-α, CCL4, CCL2, and MMP-9. This transcriptome-serum discordance highlights immune dysregulation, while HDx appears to attenuate inflammation; the shift toward anti-inflammatory signals suggests potential clinical benefit.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"612-625"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653416","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}