Blood Purification最新文献

{"title":"Epidemiology, Risk Factors and Outcomes of AKI and CRRT in Patients on ECMO: Workgroup Statements from the Joint Acute Disease Quality Initiative (ADQI) and Extracorporeal Life Support Organization (ELSO) Consensus Conference on ECMO, AKI, fluid management and CRRT.","authors":"Kianoush Kashani, David T Selewski, Katja M Gist, Marlies Ostermann, Ravindra L Mehta, Claudio Ronco, Sean M Bagshaw, Graeme MacLaren, David J Askenazi, Natalie E Rintoul, Gurmeet Singh, Ahmad Kaddourah","doi":"10.1159/bpu/abpag013","DOIUrl":"https://doi.org/10.1159/bpu/abpag013","url":null,"abstract":"<p><p>Extracorporeal life support (ECLS), most commonly delivered as extracorporeal membrane oxygenation (ECMO), is a lifesaving therapy for refractory cardiac and respiratory failure. Acute kidney injury (AKI) is among the most frequent complications associated with ECMO, occurring in 40-80% of patients, with approximately 40-50% receiving continuous renal replacement therapy (CRRT). AKI in this setting is multifactorial, reflecting pre-ECMO shock or hemodynamic instability, systemic inflammation, hemolysis, venous congestion, non-pulsatile flow, nephrotoxic exposure, and fluid overload. Both AKI and CRRT among patients receiving ECMO are independently associated with increased mortality, prolonged duration of support, and long-term risk of chronic kidney disease (CKD). This review was developed in pursuit of the 36th Acute Disease Quality Initiative (ADQI XXXVI) consensus conference, during which international experts in nephrology, critical care, cardiology, perfusion, and extracorporeal support convened to evaluate current evidence and generate consensus statements regarding the epidemiology, prevention, and management of AKI in patients receiving ECLS. The conference emphasized harmonization of definitions, identification of modifiable risk factors, optimization of CRRT strategies, and prioritization of future research directions. We highlight key epidemiologic patterns, mechanistic drivers, CRRT utilization, short- and long-term outcomes, and research priorities. Particular attention is given to the need for standardized definitions, prospective multicenter trials, biomarker validation, and integration of nephrology expertise into ECMO programs to improve kidney-related outcomes in this high-risk population.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928825","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":"Early Mortality in Incident Hemodialysis Patients: Risk Factors and Nomogram Prediction.","authors":"Shuyuan Zhang, Xi Wang, Ping Zeng, Weilong Li, Hanchao Gao, Xing Wei, Zigan Xu, Shanshan Wang, Dongna Li, Shaodong Luan, Xinzhou Zhang","doi":"10.1159/bpu/abpag012","DOIUrl":"10.1159/bpu/abpag012","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, the number of end-stage renal disease patients on hemodialysis is rising, but most of the research related to death has focused on the maintenance hemodialysis period, while there is few analyses related to the risk of death in the initial hemodialysis and lack of the risk prediction model for the early death. Hence, this study aimed to investigate these patients and establish a death risk prediction model.</p><p><strong>Methods: </strong>From January 1, 2015, to November 30, 2021, the Shenzhen Dialysis Database registered a total of 7,767 dialysis patients. We used the multiple imputation method to handle missing data and employed LASSO regression to screen variables, constructing univariate and multivariate Cox regression models to predict the risk of premature death. Finally, we drew nomogram diagrams and ROC curves for visual presentation.</p><p><strong>Results: </strong>This study included 5,841 patients with a median follow-up of 1.0 year. While the overall mortality rate across the entire observation period was 2.1 per 100 patient-years (208 total deaths), the mortality risk was disproportionately concentrated in the early phase, with 54 deaths occurring during the first 90 days, representing a cumulative incidence of 0.92% (54/5,841). Multivariate Cox regression analysis identified advanced age, non-cuffed central venous catheter use, coexisting cardiovascular/cerebrovascular diseases, and elevated C-reactive protein (CRP) as independent risk factors for 90-day mortality. Conversely, hemodialysis combined with hemodiafiltration (HD + HDF) was identified as a strong independent protective factor (HR = 0.504). A single-chart model was successfully constructed. This model demonstrated excellent discrimination throughout the entire follow-up period (optimism-corrected Harrell's C-index = 0.888) and had strong predictive accuracy for the 90-day mortality parameter (AUC = 0.906).</p><p><strong>Conclusion: </strong>This study found that being 75 years old or above was a key risk factor for 90-day mortality among newly admitted dialysis patients, with a 16-fold increase in risk. The established risk model provides preliminary clinical benefits for early individualized risk stratification. However, large-scale, multicenter prospective studies are still needed to externally validate the model and confirm its wide clinical applicability.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905187","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":"Does the Modified Global Removal Score Accurately Reflect Dialytic Performance? Comments on \"Expanded Hemodialysis as an Alternative to Suboptimal Online Hemodiafiltration\".","authors":"Francisco Maduell, Elena Cuadrado-Payán, Isabel Galceran, José Jesús Broseta","doi":"10.1159/bpu/abpag011","DOIUrl":"10.1159/bpu/abpag011","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896639","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":"Understanding Myoglobin Adsorption Kinetics: An ex-vivo Model.","authors":"Matteo Marcello, Gonzalo Ramirez-Guerrero, Anna Lorenzin, Gerd Klinkmann, Natascha Perin, Grazia Maria Virzì, Massimo de Cal, Thiago Reis, Monica Zanella, Claudio Ronco","doi":"10.1159/bpu/abpag009","DOIUrl":"10.1159/bpu/abpag009","url":null,"abstract":"<p><strong>Introduction: </strong>Myoglobin is a middle molecule protein released into the bloodstream during rhabdomyolysis, where it contributes to acute kidney injury through hemodynamic, oxidative, and obstructive mechanisms. High cutoff membranes may enhance myoglobin clearance but carry a risk of clinically relevant albumin and other protein losses. Hemoadsorption may overcome these limitations. This study aimed to assess the adsorption capacity of a neutral microporous styrene-divinylbenzene copolymer sorbent for myoglobin.</p><p><strong>Methods: </strong>We performed two ex vivo hemoadsorption experiments using mini-modules of the HA380 cartridge. Dialysis effluent from a patient with severe rhabdomyolysis was concentrated to 1 L and circulated in a closed loop at 200 mL/min for 240 min. Experiments differed in sorbent mass (32 g vs. 10.6 g). Myoglobin concentrations were measured at predefined time points using ELISA. Removal ratio (RR) and adsorbed mass were calculated to estimate adsorption kinetics and resin capacity.</p><p><strong>Results: </strong>In the first experiment (32 g sorbent), myoglobin decreased from 66,356 to 8,553 µg/L (RR 87%), with 57.8 mg adsorbed (1.8 mg/g). In the second experiment (10.6 g sorbent), concentration decreased from 76,455 to 7,043 µg/L (RR 91%), with 69.6 mg adsorbed (6.56 mg/g). In both experiments, >50% of total myoglobin was removed within the first 60 min, while adsorption plateaued during the last 3 h, suggesting near saturation without complete exhaustion of binding sites.</p><p><strong>Conclusions: </strong>This is the first study to evaluate the myoglobin adsorption capacity of a polystyrene-divinylbenzene sorbent, demonstrating a high affinity for myoglobin with near-complete removal in an ex vivo model. Although saturation was not fully reached, the maximal capacity of the resin is likely higher than measured. These findings provide quantitative insight into myoglobin adsorption kinetics and support further in vitro and clinical studies to optimize timing and duration of hemoadsorption in severe rhabdomyolysis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878873","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":"Effects of Blood Purification as an Adjunctive Treatment in Pediatric Septic Shock.","authors":"Nopparak Chanburanavach, Pasita Puttiteerachot, Nattachai Anantasit","doi":"10.1159/bpu/abpag014","DOIUrl":"10.1159/bpu/abpag014","url":null,"abstract":"<p><strong>Introduction: </strong>Septic shock remains a major cause of early mortality in pediatric intensive care units. Blood purification (BP) has been used as an adjunctive therapy to modulate hyperinflammation, but pediatric evidence, particularly regarding optimal timing, remains limited. This study aimed to compare outcomes between standard treatment and adjunctive BP in children with persistent vasoactive-dependent septic shock and to identify factors associated with early survival.</p><p><strong>Methods: </strong>We performed a retrospective-prospective observational cohort study of children aged 1 month to 18 years admitted to the pediatric intensive care unit between January 2020 and December 2024 with vasoactive-inotropic score (VIS) ≥20 for >6 h. The BP group received HA330® hemoadsorption based on intensivist discretion, while the control group received standard care. The primary outcome was 72-h survival after the diagnosis of persistent vasoactive-dependent septic shock. Secondary outcomes included severity score changes, ventilator-free days, and 30-day mortality.</p><p><strong>Results: </strong>Fifty-seven patients were included (BP n = 12; control n = 45) in this study. The BP group had greater baseline severity. Overall, 72-h survival did not differ between groups. However, BP initiation at lactate <8 mmol/L was associated with significantly improved 72-h survival (87.5 vs. 0%; p = 0.04). Early initiation within 12 h and PELOD-2 <12 showed trends toward improved survival (50 vs. 0%; p = 0.08, and 75 vs. 0%; p = 0.06, respectively). Among survivors, VIS decreased significantly after BP therapy from 72.5 (IQR 48, 138.8) to 50 (IQR 24.8, 85) at 6 h and to 30 (IQR 19.3, 51.3) at 24 h (p = 0.02).</p><p><strong>Conclusion: </strong>BP was frequently used in more severely ill children and was not associated with improved survival overall. However, early initiation, particularly before marked lactate elevation and severe organ dysfunction, may improve early survival. These findings highlight timing as a key determinant of BP effectiveness in children with persistent vasoactive-dependent septic shock.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878964","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":"Evaluation of Eryptosis Induced by Bacterial Concentrations in Sepsis: A Translational Approach.","authors":"Gonzalo Ramírez-Guerrero, Massimo de Cal, Natascha Perin, Cristian Pedreros-Rosales, Alessia Maccà, Monica Zanella, Claudio Ronco","doi":"10.1159/bpu/abpag015","DOIUrl":"10.1159/bpu/abpag015","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a life-threatening condition driven by a dysregulated immune response to infection, often leading to multi-organ failure and high mortality. Beyond oxygen transport, red blood cells (RBCs) may contribute to sepsis pathophysiology through eryptosis, a form of programmed RBC death characterized by cell shrinkage, membrane changes, and phosphatidylserine exposure. This study explored the association between bacterial exposure and eryptosis, assessing its potential as a biomarker for sepsis progression.</p><p><strong>Methods: </strong>Three in vitro experiments were conducted using RBCs from healthy donors. First, baseline eryptosis was evaluated over time in the absence of bacterial exposure. Second, RBCs were exposed to different concentrations of Staphylococcus aureus and Escherichia coli to assess the relationship between bacterial load and eryptosis. Finally, both bacterial species were tested at equal concentrations to compare their pro-eryptotic effects. Eryptosis was assessed by flow cytometry using Annexin V-FITC staining.</p><p><strong>Results: </strong>Eryptosis increased over time under control conditions, although activation remained low at 72 h. Exposure to bacteria resulted in a time- and concentration-dependent increase in eryptosis. In the experiment using different bacterial concentrations, S. aureus induced greater eryptosis than E. coli at the tested doses. However, when both bacteria were evaluated at equal concentrations, E. coli induced higher eryptosis levels than S. aureus.</p><p><strong>Conclusion: </strong>Eryptosis may serve as a biomarker of sepsis severity, sensitive to bacterial type and concentration. Gram-negative bacteria, particularly E. coli, caused greater RBC injury at comparable bacterial loads. These findings warrant further investigation into eryptosis as a potential diagnostic tool and therapeutic target in sepsis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878942","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":"Depletion of Uric Acid by Continuous Kidney Replacement Therapy.","authors":"Seolhyun Lee, William Vasquez Espinosa, Tammy L Sirich, Timothy W Meyer","doi":"10.1159/bpu/abpag008","DOIUrl":"10.1159/bpu/abpag008","url":null,"abstract":"<p><strong>Introduction: </strong>Uric acid levels are commonly elevated in patients maintained on hemodialysis because hemodialysis provides a lower time-averaged uric acid clearance than the native kidney. However, continuous kidney replacement therapy (CKRT) provides higher time-averaged clearances of small solutes than hemodialysis. We therefore examined whether the high small solute clearance provided by CKRT would reduce plasma uric acid levels below normal.</p><p><strong>Methods: </strong>We measured plasma levels of uric acid and other selected solutes in 10 patients initiating CKRT and in 17 patients maintained on CKRT for 5-110 days. We estimated solute generation rates from their removal rates. The removal rates of uric acid and phosphate were estimated from their plasma levels, while those of urea and creatinine were calculated directly from their effluent levels. CKRT prescription met current guidelines (24 ± 2 mL/kg/h in patients initiating CKRT and 26 ± 3 mL/kg/h in patients maintained longer on CKRT).</p><p><strong>Results: </strong>Plasma uric acid levels declined from 8.7 ± 3.0 mg/dL to 1.8 ± 0.5 mg/dL after 2-4 days of initiating CKRT (p < 0.001) and were similarly low at 1.7 ± 0.6 mg/dL during ongoing CKRT. Plasma uric acid levels at both intervals were below the normal range. The average uric acid removal rate was not different at 2-4 days post-initiation (922 ± 367 mg/day) and during ongoing CKRT (855 ± 346 mg/day).</p><p><strong>Conclusion: </strong>CKRT prescribed according to current guidelines reduces uric acid levels below normal. The clinical consequences of low uric acid levels in this setting are unknown.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872939","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":"Benefits and Challenges of Telemedicine Utilization in Peritoneal Dialysis Management in Low-Resource Settings.","authors":"Ana Elizabeth Figueiredo, Viviane Calice-Silva, Daniela Ponce","doi":"10.1159/bpu/abpag010","DOIUrl":"10.1159/bpu/abpag010","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD) is a cost-effective and home-based kidney replacement therapy, particularly relevant in low- and middle-income countries (LMICs). However, outcomes remain suboptimal due to limited access to specialized care, delayed complication detection, and workforce constraints. Telemedicine has emerged as a potential strategy to address these challenges.</p><p><strong>Summary: </strong>This integrative narrative review aimed to synthesize current evidence on telemedicine interventions in PD management, focusing on clinical effectiveness, implementation strategies, and applicability in resource-limited settings. A structured literature search was conducted in PubMed, Scopus, and Google Scholar for studies published between 2010 and 2025. Eligible studies included observational studies, clinical trials, and implementation reports evaluating telemedicine modalities such as remote patient monitoring (RPM), mobile health (mHealth), teleconsultation, and tele-education in PD populations. The evidence indicates that RPM-enabled automated PD is associated with significant reductions in all-cause mortality, cardiovascular events, hospitalization rates, and technique failure. Additional benefits include improved treatment adherence, enhanced fluid management, and earlier detection of complications. Cost-related data suggest reductions in healthcare utilization (direct costs) and patient-related burden such as travel and productivity loss (indirect costs), although formal economic evaluations remain limited. Implementation in LMICs is feasible but requires adaptation to local infrastructure, digital literacy, and health system capacity.</p><p><strong>Key messages: </strong>Telemedicine-supported PD, particularly RPM, is associated with consistent clinical benefits and improved care delivery. Successful implementation in low-resource settings depends on user-centered design, workforce training, sustainable financing models, and supportive regulatory frameworks.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817194","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":"Differences in Pediatric Continuous Renal Replacement Therapy Initiation and Prescription Practices between the jpCRRT Registry and the WE-ROCK Cohort.","authors":"Taiki Haga, Ryuta Itakura, Yuji Yamagami, Kenji Sonota, Takuya Miyazawa, Shunsuke Noda, Sho Wada, Hiroshi Sakihama, Takuya Hayashi, Naoki Fujiwara, Yuki Ichisaka, Hiroshi Okada, Kohei Tsukahara, Mai Miyaji, Kazufumi Yaginuma, Akito Horikawa, Taku Koizumi, Shinya Takarada, Norio Omori, Keiichiro Toma, Wataru Sakai, Takafumi Obara, Takahiro Matsudo","doi":"10.1159/bpu/abpag007","DOIUrl":"10.1159/bpu/abpag007","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric continuous renal replacement therapy (CRRT) practice varies across regions, but contemporary registry-based comparisons are limited. We aimed to compare the patient characteristics, pre-CRRT status, and initial CRRT prescription patterns between the published Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) cohort and a WE-ROCK-aligned cohort from the Japanese Pediatric Continuous Renal Replacement Therapy (jpCRRT) Registry.</p><p><strong>Methods: </strong>This descriptive comparison used jpCRRT data collected from January 2023 to March 2026 from 13 participating PICUs in Japan and published aggregate data from WE-ROCK. To improve comparability, we excluded patients receiving maintenance dialysis before CRRT initiation, those treated with concomitant extracorporeal membrane oxygenation, and those receiving CRRT for metabolic or drug/toxin indications. The resulting WE-ROCK-aligned jpCRRT cohort comprised 70 patients.</p><p><strong>Results: </strong>Compared with the WE-ROCK cohort, the jpCRRT cohort was younger and had lower body weight, with a shorter interval from intensive care unit admission to CRRT initiation. The pre-CRRT urine output and serum creatinine levels were broadly similar between the cohorts. The initial CRRT practices differed substantially; continuous venovenous hemodialysis predominated in jpCRRT, whereas continuous venovenous hemodiafiltration predominated in WE-ROCK. Non-polysulfone membranes and nafamostat-based anticoagulants were common in jpCRRT, whereas polysulfone membranes and citrate anticoagulants were more frequently used in WE-ROCK. In contrast, vascular access distribution, blood flow rate, and prescribed CRRT dose were similar. Death before intensive care unit discharge occurred in 18.6% of the jpCRRT cohort and 35.8% of the WE-ROCK cohort.</p><p><strong>Conclusion: </strong>Contemporary pediatric CRRT practice differed between the published WE-ROCK cohort and the restricted jpCRRT cohort, particularly in terms of modality, filter type, and anticoagulation strategies. These findings suggest that pediatric CRRT practice is shaped by both regional implementation and patient case mix. Future international studies should use harmonized definitions and comparable outcome frameworks to better evaluate cross-regional differences in pediatric CRRT practice.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811899","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":"Changes in Central Venous Oxygen Saturation during Inpatient Hemodialysis.","authors":"Christina Hao Wang Brotman, Molly Kennelly, Charles Hull, Clara Walling, Michael Shashaty, Jesse Yenchih Hsu, Dan Negoianu, Laura M Dember","doi":"10.1159/bpu/abpag006","DOIUrl":"10.1159/bpu/abpag006","url":null,"abstract":"<p><strong>Introduction: </strong>Ultrafiltration during hemodialysis can precipitate intradialytic hypotension (IDH), particularly in hospitalized patients with limited cardiovascular reserves. Central venous oxygen saturation (ScvO2) is a surrogate marker of cardiac output and may provide real-time insights into hemodynamic stress during dialysis.</p><p><strong>Methods: </strong>We analyzed data from a prospective observational study of hospitalized adults receiving intermittent hemodialysis with central venous catheters for either acute kidney injury (AKI) or end-stage kidney disease. Continuous ScvO2 was measured throughout the dialysis sessions using Crit-Line-IV. Mixed-effects models were used to characterize intradialytic ScvO2 trends, with restricted cubic splines to evaluate the associations between ScvO2 slopes, ultrafiltration rate (UFR), and IDH.</p><p><strong>Results: </strong>During 204 hemodialysis sessions among 135 individual participants, ScvO2 declined during 58% of the sessions, with substantial inter-patient variability in ScvO2 slopes. Steeper negative ScvO2 slopes were associated with a higher risk of IDH across all IDH definitions, particularly among patients with AKI. Hemodialysis sessions with the steepest ScvO2 declines (defined as the bottom 25th) were associated with increased risk of requiring an intervention for hemodynamic instability, independent of UFR and pre-dialysis blood pressure (adjusted OR: 2.42, 95% CI: 1.12, 5.20). This association was enhanced in patients with AKI (adjusted OR: 5.80, 95% CI: 2.05, 16.46).</p><p><strong>Conclusions: </strong>Continuous intradialytic ScvO2 monitoring is feasible in hospitalized patients and may identify patients at higher risk of hemodynamic instability, especially among those with AKI. ScvO2 may be a useful adjunct for guiding ultrafiltration during inpatient hemodialysis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787864","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}