Blood Purification最新文献

{"title":"Advances in Renal Replacement Therapy: The Role of Polymethyl Methacrylate Membranes in Acute Critically Ill Patients.","authors":"Eleonora Balzani, Sergio Lassola, Hannah Wozniak, Giacomo Bellani, Silvia De Rosa","doi":"10.1159/000543856","DOIUrl":"10.1159/000543856","url":null,"abstract":"<p><strong>Background: </strong>Polymethyl methacrylate (PMMA) membranes are increasingly recognized for their effectiveness in treating acute kidney injury (AKI) due to their strong adsorption capabilities, particularly for inflammatory mediators like β2-microglobulin and IL-6. These membranes ensure mechanical stability and chemical inertness, minimizing adverse reactions during blood filtration.</p><p><strong>Summary: </strong>In acute conditions such as sepsis and acute respiratory distress syndrome (ARDS), PMMA membranes show promising findings. In sepsis, they may help reduce multiorgan failure by modulating immune responses, although further research is needed to confirm their routine use. For ARDS, PMMA membranes could mitigate \"cytokine storms\" by adsorbing key cytokines, improving oxygenation and hemodynamic stability, which may reduce ICU stays and reliance on mechanical ventilation. Monitoring biomarkers like IL-6, TNF-α is critical for tracking efficacy and tailoring therapy to individual needs. In chronic conditions, such as hemodialysis for chronic kidney disease, PMMA membranes help lower oxidative stress and β2-microglobulin levels, reducing complications such as amyloidosis. By decreasing oxidative damage, they provide long-term protective benefits for dialysis patients.</p><p><strong>Key message: </strong>While these advantages are notable, large-scale studies are needed to establish PMMA's efficacy, refine treatment protocols, and confirm its broader role in acute and chronic disease management. The potential of PMMA membranes highlights their value, but standardized clinical evidence is necessary for widespread adoption.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Brozat et al. Albumin and platelet loss during the application of CytoSorb® in critically ill patients: a post-hoc analysis of the Cyto-SOLVE trial.","authors":"Benedetta Savasta, Martina Giacco, Federico Pappalardo","doi":"10.1159/000545179","DOIUrl":"https://doi.org/10.1159/000545179","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-4"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"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":"1-12"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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}