Blood Purification最新文献

{"title":"Alternative vs. conventional hemodialysis regimen: one size does not fit all.","authors":"Carolina S Wagner, Andrea O Magalhães, Cynthia M Borges, Sidney T Sasaki, Daniel R Alves, Eduardo P Luciano, Fernando T Nakagawa, Ricardo M Oliveira, Whellington F Rocha, Rosilene M Elias","doi":"10.1159/000546452","DOIUrl":"https://doi.org/10.1159/000546452","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis regimen and setting (home or in the center), whenever possible, should be a patient choice. While a frequent and more intensive schedule has clinical benefits, incremental or decremental dialysis is a choice in specific clinical scenarios. In Brazil, dialysis is mostly funded by the public health system and modality other than conventional 3 times a week is affordable only for patients with private health insurance. We had the opportunity to investigate the characteristics of patients triaged into a given modality/schedule clinical in a private center.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who initiated hemodiafiltration at home or in the facility between January 1st, 2021, and January 1st, 2024. Patients were divided into 4 groups: A (incremental/decremental, N=11, < 3 times a week or < 12 hours/week); B (conventional, N=64, 3 to 4 times a week); C (short daily, N=46, 5-6 times a week); D (long nocturnal, N=17, 6-8 hours 3-4 times a week). We evaluated the clinical and laboratory features of patients according to each group while initiating therapy and hospitalization rate.</p><p><strong>Results: </strong>Patients allocated to group D were younger and less likely to have diabetes, 94.1% had an arteriovenous fistula, 64.7% were employed, and had higher albumin and phosphate when starting the modality (p<0.05 for all comparisons). Patients on home dialysis were older, mostly on short daily dialysis, most likely to have diabetes and use a catheter, and had lower hemoglobin, albumin and parathormone levels at the modality initiation (p<0.05 for all comparisons). Hospitalization rates did not differ among groups.</p><p><strong>Conclusion: </strong>Younger patients tended to choose a nocturnal in-center regime whereas older patients tended to choose more frequent home dialysis. This information is critical to planning a dialysis portfolio that fits patients' needs when initiating dialysis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-14"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324439","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":"Optimizing Safety and Efficacy in Pediatric CRRT: The Promise of Diluted Regional Citrate Anticoagulation.","authors":"Minmin Wang, Wenxiong Li, Qiang Yao","doi":"10.1159/000546705","DOIUrl":"https://doi.org/10.1159/000546705","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233072","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":"Hypertonic Citrate Solution Protocol Associated with Longer Filter Lifetime in Critically Ill Patients Requiring Continuous Kidney Replacement Therapy.","authors":"Anyarin Wannakittirat, Khanittha Yimsangyad, Nuttha Lumlertgul, Sadudee Peerapornratana, Nattachai Srisawat","doi":"10.1159/000546579","DOIUrl":"https://doi.org/10.1159/000546579","url":null,"abstract":"<p><strong>Background: </strong>Regional citrate anticoagulation (RCA) serves as the first line of anticoagulants in continuous kidney replacement therapy (CKRT). Premature circuit clotting is associated with increased workload, costs, and adverse patient outcomes. Current evidence shows limited studies on the relationship between RCA protocols and circuit clotting in RCA CKRT. The study aims to investigate the factors influencing filter lifetime that lead to premature circuit clotting, including citrate formulas employed during RCA in CKRT.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at a single center and included patients receiving CKRT from February 2023 to September 2023. The primary outcome was the identification of factors associated premature circuit clotting. Secondary outcomes included circuit ionized calcium levels, citrate doses, blood transfusions, citrate formulations, and other variables that may impact filter clotting.</p><p><strong>Results: </strong>A total of 199 filters from 97 patients were analyzed in this study. After exclusion of circuit termination due to non-clotting event, 38 filters experienced premature circuit clotting (lifetime ≤ 72 hours), while 70 filters clotted after 72 hours. The baseline characteristics and clinical outcomes were well balanced between the groups. In the multivariable analysis, only isotonic citrate formulations (RR 2.45, 95% CI 1.17-5.14, p = 0.018) and corrected citrate doses (RR 0.48, 95% CI 0.27-0.87, p = 0.016) exhibited statistically significant associations with filter premature clotting.</p><p><strong>Conclusions: </strong>Different RCA prescriptions may affect filter lifetime and circuit integrity. Notably, the hypertonic RCA protocol was associated with a significantly longer filter lifetime compared to the isotonic RCA protocol. However, additional data from rigorously constructed randomized controlled trials are needed.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-20"},"PeriodicalIF":2.2,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198241","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":"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":"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 JS,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. JS,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 JS,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 JS,Cl from the CLODICUS study (NCT04755491) were recomputed using this methodology.</p><p><strong>Results: </strong>We studied 10 patients with 18 observations. Dialysate JS,Cl was significantly lower than plasma JS,Cl (0.21 [0.07 to 0.24] vs. 0.31 [0.15 to 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 to 217) mL.h-1, and the dialysate JS,Cl to 0.11 (-0.01 to 0.23) mmol.min-1. Increasing net ultrafiltration flow was associated with increasing dialysate JS,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":"1-9"},"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":"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 induce 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":"1-12"},"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":"10.1159/000546256","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to conduct a meta-analysis and systematic review to assess the efficacy of hemoperfusion (HP) in patients with severe coronavirus disease 2019 (COVID-19).</p><p><strong>Methods: </strong>A comprehensive search for candidate publications was performed using PubMed, Cochrane Library, and Embase. Studies investigating the effect of HP on mortality among severe COVID-19 patients were selected, including randomized controlled trials (RCTs), non-RCTs, and observational studies with control groups. The primary endpoint was the longest reported mortality, while the secondary endpoints were the length of stay, intensive care unit (ICU) stay, P/F ratio, and C-reactive protein (CRP). The Cochrane test (Q) and I2 test were used to quantify heterogeneity among the studies. The fixed-effect model (Mantel-Haenszel method) would be selected when there is no heterogeneity (p > 0.10 and I2 <50%), whereas the random-effect 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, and I2.</p><p><strong>Results: </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 HP 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 HP 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 HP group had a longer hospital stay compared with the control group (weighted mean difference; 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 HP, the P/F ratio (WMD 95.79 [74.46, 117.12] mm Hg; 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><p><strong>Conclusion: </strong>This study found that HP did not significantly reduce mortality in COVID-19 patients; however, the HA series showed potential mortality benefits, suggesting its clinical applicability. While the HP group had longer hospital stays, ICU stay durations did not differ significantly. Notably, HP improved the P/F ratio and reduced CRP levels post-treatment.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-20"},"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":"Haemoadsorption in Paediatric Critical Care: Current Insights and Future Perspectives.","authors":"Gabriella Bottari, Isabella Guzzo, Akash Deep","doi":"10.1159/000546240","DOIUrl":"10.1159/000546240","url":null,"abstract":"<p><strong>Background: </strong>Haemoadsorption (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 haemodynamic 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>(1) HA shows significant promise in paediatric septic shock, liver failure, and rhabdomyolysis. (2) Technical advancements are expanding HAs applicability to neonates and small infants. (3) 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":"1-8"},"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":"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 dialyzate. The resulting large volumes of reject water are usually discarded. With the rising water crisis both in the USA 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 dialyzate unless it undergoes further purification. This results in a large amount of reject water, which can be from 50 to 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":"1-8"},"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}