Blood Purification最新文献

{"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}

{"title":"Association of hypoalbuminemia with the risk of peritoneal dialysis-associated peritonitis in peritoneal dialysis patients: a meta-analysis.","authors":"Danfeng Zha, Xionghao Yang, Huiqin Xi","doi":"10.1159/000543693","DOIUrl":"https://doi.org/10.1159/000543693","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this meta-analysis was to assess the association between hypoalbuminemia and the risk of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving peritoneal dialysis (PD).</p><p><strong>Methods: </strong>By the specified deadline of November 13, 2023, a systematic search across various databases was conducted to identify relevant literature. The databases searched included PubMed, Embase, the Cochrane Library, Web of Science, the China National Knowledge Infrastructure (CNKI), WanFang, and VIP. The effect sizes were quantified using odds ratios (OR) or hazard ratios (HR) and were presented with 95% confidence intervals (CI). The analysis was stratified by the type of PD [continuous ambulatory peritoneal dialysis (CAPD), mixed] and the timing of albumin (ALB) level measurements (at baseline, after initiation of PD, or average over time).</p><p><strong>Results: </strong>A total of 14 studies encompassing 6,448 PD patients were incorporated in this meta-analysis. The findings revealed a significantly elevated risk of peritonitis in patients with hypoalbuminemia compared to those with an ALB level above 3.5g/dL (OR: 2.70, 95% CI: 1.78 to 4.09, P <0.001). Stratification by PD modality showed consistent results within the CAPD group (OR: 5.79, 95% CI: 3.57 to 9.41, P <0.001). For the timing of ALB measurements, the baseline measurement group maintained these findings (OR: 2.53, 95% CI: 1.40 to 4.58, P =0.002), while the group with post-PD measurements did not show statistical significance (OR: 0.76, 95% CI: 0.49 to 1.17, P =0.212). The HR analysis similarly indicated an increased risk of peritonitis in hypoalbuminemia patients compared to those with higher serum ALB levels (HR: 1.62, 95% CI: 1.44 to 1.82, P <0.001).</p><p><strong>Conclusion: </strong>Our meta-analysis reveals that hypoalbuminemia raises the risk of peritonitis in PD patients, particularly at baseline. This finding underscores the need for close monitoring to detect peritonitis early. Further research is needed to understand the impact of ALB levels post-PD initiation on peritonitis risk.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-23"},"PeriodicalIF":2.2,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390061","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":"100 Years of Dialysis at University Hospital Giessen.","authors":"Faeq Husain-Syed, Ulrike Enke, Friedrich Lübbecke, Winfried Fassbinder, Friedrich Grimminger, Horst-Walter Birk","doi":"10.1159/000543874","DOIUrl":"10.1159/000543874","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188047","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":"e-Prescribing, Charting, and Documentation for Continuous Renal Replacement Therapy: A Green Intensive Care Unit and Nephrology Initiative.","authors":"Ian Baldwin, Jian Wen Chan, Stuart Downs, Connor Palmer","doi":"10.1159/000541487","DOIUrl":"10.1159/000541487","url":null,"abstract":"<p><strong>Background: </strong>Patient care informatics are becoming more advanced with digital capacity and server functionality. The intensive care unit (ICU) is becoming paperless for prescribing, charting, and monitoring care. A further challenge is to include all life sustaining therapies in this digital space. Digital modules and options may be available; however, continuous renal replacement therapies (CRRTs) often require custom design for many nuances. Associated with the COVID pandemic and a surge in the paperless and \"green\" ICU bedside, we gathered a team to design, develop, and implement a CRRT orders, charting-documentation, and monitoring functionality into our existing Cerner (ORACLE Corp., Austin, Texas, USA) software.</p><p><strong>Key messages: </strong>This included new approaches to the two-dimensional paper documents used prior and a live dashboard with new metrics and data. The design linked to other relevant CRRT pages such as the master patient fluid balance, pathology results, and medication prescribing. The primary views and function are role-related for medical, nursing, and pharmacy with specific and sensitive input. Following the build and implementation, initial evaluation was positive and led to an audit trail or e-history for prescribers use and provision for concurrent therapies. Clinicians use this digital ordering differently with live data available for \"handover\" and case discussion. There is scope for research and further links to devices such as personal phones and via an app.</p><p><strong>Summary: </strong>This experience may assist CRRT users design and develop similar prescribing, charting, and monitoring bedside computer opportunities in the desire for digital and green nephrology in the ICU.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"18-27"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280093","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":"Anticoagulation Strategies for Continuous Renal Replacement Therapy in France: A Survey of Practices.","authors":"Justine Pible, Frank Bidar, Nicolas Chardon, Valérie Cerro, Carole Ichai, Céline Monard, Antoine Schneider, Olivier Joannes-Boyau, Jean-Michel Constantin, Thomas Rimmelé","doi":"10.1159/000540553","DOIUrl":"10.1159/000540553","url":null,"abstract":"<p><strong>Introduction: </strong>Anticoagulation for continuous renal replacement therapy (CRRT) can be performed using systemic anticoagulation or regional citrate anticoagulation (RCA). The 2012 Kidney Disease Improving Global Outcomes guidelines support the use of RCA as the first-line strategy in patients requiring CRRT, with and without bleeding risk. Implementing RCA in the intensive care unit (ICU) implies involving all medical and nursing staff. The primary objective of this study was to report and describe the various anticoagulation strategies for CRRT in French ICUs. The secondary objectives were to determine the rate of RCA use and to identify the factors limiting its implementation.</p><p><strong>Methods: </strong>An online questionnaire containing 40 questions was sent to attending physicians and fellows practicing in French ICUs between May and September 2021. The questionnaire was sent via several networks: mailing list from the French Society of Anesthesia and Intensive Care Medicine and mailing lists of RRT manufacturers.</p><p><strong>Results: </strong>A total of 597 responses were analyzed. RCA was used by most of the participants for patients with (81%) and without (80%) increased bleeding risk. The preferred CRRT modality of the participants while using RCA was continuous veno-venous hemodialysis (48%). The clinical situations frequently reported as an absolute contraindication to RCA were uncontrolled shock associated with liver failure and drug poisoning impairing citrate metabolism (62% and 52%, respectively). In case of a higher risk of citrate accumulation, most participants claimed to perform closer biological monitoring (57%) or to modify the CRRT protocol (61%). Among the participants who did not prescribe RCA as a first-line strategy, the main factors limiting its implementation were the lack of nurse (50%) or physician (34%) training.</p><p><strong>Conclusion: </strong>RCA is the main anticoagulation strategy prescribed for CRRT in France. Providing medical and nursing staff easy access to training may facilitate the understanding and use of RCA as the first-line anticoagulation strategy for CRRT.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142340992","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":"Urgent-Start Peritoneal Dialysis in Metformin-Associated Lactic Acidosis: A Critical Alternative when Immediate Hemodialysis Is Unavailable.","authors":"Watanyu Parapiboon, Jakkrid Banjong, Chirakhana Siangtrong, Theerapun Boonsayomphu, Wirayut Silakun","doi":"10.1159/000542003","DOIUrl":"10.1159/000542003","url":null,"abstract":"<p><strong>Introduction: </strong>Intermittent hemodialysis (IHD) is a preferable renal replacement therapy (RRT) option in metformin-associated lactic acidosis (MALA) due to rapid correct metabolic acidosis. However, IHD might not be started immediately. Immediate urgent-start peritoneal dialysis (iUSPD) is used as a life-saving dialysis option and then followed by IHD. The outcomes of iUSPD were compared with other extracorporeal dialysis in MALA.</p><p><strong>Methods: </strong>In two tertiary hospitals in Thailand, the outcomes of patients with MALA who had received three different RRT modalities (iUSPD followed by IHD, IHD, and continuous renal replacement therapy [CRRT]) from January 2015 to December 2019 were compared. The primary outcome was 30-day mortality. The secondary outcomes were door-to-dialysis time and 90-day RRT dependence.</p><p><strong>Results: </strong>A total of 180 MALA cases that required dialysis were included (20 iUSPD, 120 IHD, and 40 CRRT). Their mean age was 64 years. Most of the patients had severe metabolic acidosis (mean pH 6.91, HCO3 6 mmol/L, and anion gap 40 mmol/L) and were critically ill. The 30-day mortality was 30% in iUSPD, 9.2% in IHD, and 32.5% in CRRT (p = 0.001). The mortality risk in the iUSPD group was not significantly different from those of the IHD and CRRT groups (adjusted HR 2.5, 95% CI: 0.65-9.6, and adjusted HR 0.75, 95% CI: 0.2-2.78, respectively). All dialysis modalities had comparable 90-day dialysis dependence. iUSPD exhibited the shortest door-to-dialysis time.</p><p><strong>Conclusion: </strong>In MALA, iUSPD followed by IHD might be a viable RRT option to save patient lives if no other dialysis options are available.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"9-17"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457194","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":"Prevalence of Patent Processus Vaginalis Diagnosed Using Laparoscopy during Peritoneal Dialysis Catheter Insertion and Subsequent Genital Edema: A Prospective Observational Study.","authors":"Terumasa Hayashi, Susumu Miyazaki, Kazuhiro Iwase, Taisuke Takatsuka, Daisuke Yoshimura, Tomohiro Kawamura, Yukimasa Iwata, Hiroki Okushima, Yoshiyasu Ueda, Yoshitaka Isaka","doi":"10.1159/000542588","DOIUrl":"10.1159/000542588","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal hernia and genital edema are relatively common complications of peritoneal dialysis (PD). Although patent processus vaginalis (PV) is considered an important factor associated with these complications, the prevalence of patent PV at PD initiation and whether it leads to these complications has not been fully identified.</p><p><strong>Methods: </strong>A total of 71 patients were included in this study, 41 of whom underwent laparoscopy-assisted catheter placement. The remaining 30 patients did not undergo laparoscopy mainly because of a lack of patient consent. During laparoscopy, if a dimple or small canal toward the deep inguinal ring was observed, the groin was diagnosed as a patent PV.</p><p><strong>Results: </strong>Laparoscopy revealed that 9 of 41 patients (22%) had patent PV (male, 29.6%; female, 7.1%). Genital edema occurred in 2 of the nine patients with patent PV at 8.9 and 11.4 months after PD initiation, respectively. However, none of 32 patients without patent PV developed this complication. Two of 30 patients without laparoscopic inspection presented with genital edema at 6.7 and 12.4 months after PD initiation, respectively. Among the 71 patients, body mass index was significantly higher in patients with this complication than in those without (28.8 vs. 22.8, p 0.013).</p><p><strong>Conclusion: </strong>Although the number of patients with patent PV who manifested genital edema was small, our results suggest that patent PV at PD initiation may be an important contributor for genital edema in patients undergoing PD. Further studies are needed to determine whether the repair of patent PV could prevent subsequent genital edema.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"141-148"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765764","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 Meropenem and Piperacillin during Experimental Hemoadsorption with the HA380 Cartridge.","authors":"Taku Furukawa, Yugeesh Lankadeva, Ian Baldwin, Pei Chen Connie Ow, Sally Hood, Antoine Schneider, Laurent A Decosterd, Clive N May, Rinaldo Bellomo","doi":"10.1159/000542332","DOIUrl":"10.1159/000542332","url":null,"abstract":"<p><strong>Introduction: </strong>Hemoadsorption can be used as adjunctive therapy for sepsis. However, there is limited evidence regarding its antibiotic removal. In this in vivo preclinical study, we aimed to evaluate the removal of meropenem and piperacillin with the HA380 hemoadsorption cartridge.</p><p><strong>Methods: </strong>Healthy adult sheep (n = 6) received 2 g of meropenem and 4 g of piperacillin intravenously for 30 min followed by hemoadsorption with a HA380 cartridge at a blood flow rate of 120 mL/min for 4 h. The sorbent-based removal ratio, clearance, and mass removal were calculated at multiple time points.</p><p><strong>Results: </strong>The sorbent-based removal ratio of meropenem decreased from 95.4% (SD 1.8) at 10 min to less than 20% at 4 h of hemoadsorption. Its cumulative sorbent-based mass removal was 386.6 mg (SD 78.8) over 4 h with 65.6% (SD 7.1) occurring in the first 60 min. In contrast, the sorbent-based removal ratio of piperacillin decreased more gradually from 98.4% (SD 0.6) at 10 min to 37.4% (SD 7.2) at 4 h. Its cumulative sorbent-based mass removal was 647.4 mg (SD 191.3) over 4 h with 63.4% (SD 4.2) occurring in the first 60 min. The overall sorbent-based clearance of piperacillin was significantly greater than meropenem (pgroup < 0.0001).</p><p><strong>Conclusion: </strong>Hemoadsorption with the HA380 cartridge removed meropenem and piperacillin throughout a 4-h period, with high clearances at the start. Our findings can be used to inform dosing decisions during hemoadsorption in septic patients, there may be the need to consider increasing the doses of these antibiotics by 15-25% to prevent underdosing.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"102-110"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575278","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}