Blood Purification最新文献

{"title":"Protocol of the Comparison of Two Different Bicarbonate Replacement Fluids during Continuous Veno-Venous Hemofiltration with Regional Citrate Anticoagulation: A Prospective, Randomized, Controlled Trial.","authors":"Paul Köglberger, Fabian Perschinka, Sebastian J Klein, Timo Mayerhöfer, Sarah Maier, Hanno Ulmer, Romuald Bellmann, Michael Joannidis","doi":"10.1159/000547401","DOIUrl":"10.1159/000547401","url":null,"abstract":"<p><strong>Introduction: </strong>Acid-base disturbances are common issues during continuous veno-venous hemofiltration (CVVH). Especially using regional citrate anticoagulation (RCA), recent studies have shown that control in intracorporal pH and HCO₃ concentration may be improved when the replacement fluid is changed to a solution with a lower <inline-formula><mml:math id=\"m1\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mtext>HCO</mml:mtext><mml:mn>3</mml:mn><mml:mo>-</mml:mo></mml:msubsup></mml:mrow></mml:math></inline-formula> concentration during continuous renal replacement therapy. This prospective trail aimed to compare acid-base balance between a high (HBF) and low (LBF) bicarbonate replacement fluid over a period of 96 h after CVVH initiation using RCA.</p><p><strong>Methods: </strong>This is a prospective, randomized, controlled, open-label, crossover, phase II, single-center study involving critically ill patients requiring RRT. The two replacement fluids (Phoxilium and Biphozyl) are compared in two groups with 1:1 block randomization and consecutive crossover after 48 h of CVVH. The primary endpoints are the occurrence of at least one pH (>7.45) or <inline-formula><mml:math id=\"m2\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mtext>HCO</mml:mtext><mml:mn>3</mml:mn><mml:mo>-</mml:mo></mml:msubsup></mml:mrow></mml:math></inline-formula> (>26 mmol/L) excursion within 16-48 h of each treatment phase using a generalized estimating equation approach. The objective was to examine differences of pH and <inline-formula><mml:math id=\"m3\" xmlns:mml=\"http://www.w3.org/1998/Math/MathML\"><mml:mrow><mml:msubsup><mml:mtext>HCO</mml:mtext><mml:mn>3</mml:mn><mml:mo>-</mml:mo></mml:msubsup></mml:mrow></mml:math></inline-formula> between patients who receive LBF and HBF as replacement fluid during CVVH. We hypothesize that during CVVH with LBF, pH, and HCO₃- excursion rates are significantly lower compared to HBF. Recruitment of 88 study participants is ongoing, with the trial expected to be completed in 2025. Data cleaning, analysis, and publication preparation will follow thereafter. The trial is registered at <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> (NCT04071171) and EudraCT (2019-001262-15).</p><p><strong>Conclusion: </strong>Given the broad inclusion and restricted exclusion criteria, we expect the results of the BiPhox-Trial to be broadly applicable to patients in need of CVVH with RCA in the intensive care setting. This trial aims to determine whether the use of LBF results in more stable acid-base parameters compared to HBF during CVVH with RCA in critically ill patients and may guide therapeutic decisions in clinical practice.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783426","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":"MCO Membranes and FGF-23: Advancing Dialysis Strategies for Better Outcomes?","authors":"Simona Barbuto, Lorenza Magagnoli, Giuseppe Cianciolo, Gaetano La Manna, Mario Cozzolino, Paola Ciceri","doi":"10.1159/000547457","DOIUrl":"10.1159/000547457","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-3"},"PeriodicalIF":1.8,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752246","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":"Interleukin-6 Removal and Clinical Effects of Oxiris: A Systematic Review and Meta-Analysis.","authors":"Arnau Ulsamer, Diego Pomarè Montin, Vittorio Bocciero, Tania Julieth Parra Morales, Lorenzo Tofani, Luca di Girolamo, Stefano Romagnoli, Gianluca Villa, Matteo Cecchi","doi":"10.1159/000547587","DOIUrl":"10.1159/000547587","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis is a life-threatening condition associated with high mortality due to an unregulated host immune response. Extracorporeal blood purification (EBP) therapies have been proposed as adjunctive treatments to immunomodulate patients; however, none have been consistently shown to be effective in reducing mortality. In several observational studies, Oxiris has been associated with cytokine reduction and a potential benefit in influencing inflammatory diseases. This meta-analysis explores the association between cytokine removal and clinical efficacy of the Oxiris membrane using interleukin-6 (IL-6) as a biomarker.</p><p><strong>Methods: </strong>This review includes articles on EBP with Oxiris membranes in adult patients with sepsis/septic shock or COVID-19. No time or language restrictions were applied to the systematic literature search. Data extraction and statistical analysis were limited to the cytokines and clinical data reported in the included articles. The most representative cytokine was IL-6 and the selected outcomes included Vasoactive-Inotropic Score (VIS), SOFA score, procalcitonin (PCT) and C-reactive protein (CRP). The review used meta-analysis and unpaired t test to estimate differences between groups of patients treated with or without Oxiris.</p><p><strong>Results: </strong>The study found no significant differences in demographics between the intervention and control groups at baseline. Intervention group showed a significant reduction in vasoactive inotropic score, norepinephrine dose, SOFA score, PCT, and CRP.</p><p><strong>Conclusion: </strong>We reviewed 8 studies in which IL-6 was significantly reduced in the Oxiris group compared to the control. This meta-analysis found that the use of the Oxiris membrane resulted in significant clinical improvement during treatment.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727744","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":"<italic>Non sibi sed omnibus</italic>: Chronic Dialysis Care through a Stakeholder Lens.","authors":"José A Moura-Neto","doi":"10.1159/000547615","DOIUrl":"10.1159/000547615","url":null,"abstract":"<p><p>Since its inception in the 1960s, chronic dialysis has undergone substantial technical evolution. Today, with over 4 million patients on renal replacement therapy worldwide, dialysis has become both a critical public health concern and a structured sector within healthcare economies. Beyond clinical innovation, a silent revolution has reshaped how dialysis units are - or should be - managed: the transition from a shareholder-centered model to one that should embrace a broader stakeholder perspective. This article explores this paradigm shift, proposes a theoretical framework for stakeholder-based dialysis unit management, and discusses its ethical and operational implications in contemporary healthcare.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-6"},"PeriodicalIF":1.8,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144706203","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 between Blood Flow Measured within 30 Days from Arteriovenous Access Creation and Thrombosis Risk.","authors":"Giacomo Scherini, Lorenza Magagnoli, Anila Cara, Giulia Boni Brivio, Iacopo Barbetta, Luca Freni, Ulisse Zoni, Diego Curtò, Andrea Stucchi, Matteo Crippa, Mario Cozzolino","doi":"10.1159/000547480","DOIUrl":"10.1159/000547480","url":null,"abstract":"<p><strong>Introduction: </strong>Arteriovenous (AV) hemodialysis accesses are hampered by the risk of thrombosis. Due to lack of evidence, current guidelines do not suggest routine assessment of AV access blood flow (Qa) for surveillance. This study aims to analyze the association between postoperative Qa and thrombosis risk, in distal and proximal autologous AV fistulae (dAVF and pAVF), and AV grafts (AVGs).</p><p><strong>Methods: </strong>This retrospective cohort study included all AV accesses created in San Paolo Hospital (Milan, IT) between 2013 and 2022, with a postoperative Qa measurement available within 30 days from creation. Thrombosis-free survival curves were plotted using the Kaplan-Meier method. The association between Qa and thrombosis risk was studied by multivariate Cox proportional hazard models. Nonlinearity was assessed using natural splines.</p><p><strong>Results: </strong>A total of 218 AV accesses (92 dAVF, 76 pAVF, and 50 AVG) were created in 191 patients. During a median follow-up time of 1.35 years, 66 AV access thrombosis occurred. In dAVF, Qa showed a significant nonlinear association with thrombosis risk, with nadir at Qa of 1,289 mL/min and an exponential risk increase for Qa <800 mL/min. In dAVF with a Qa<1,289 mL/min, there was a 43% increase in the risk of thrombosis every 100 mL/min decrease in Qa (aHR 1.43 [1.11-1.83], p 0.005). In pAVF and AVG, Qa was not associated with thrombosis risk.</p><p><strong>Conclusion: </strong>Postoperative Qa shows a nonlinear association with thrombosis risk in dAVF, suggesting that this may be a useful tool to identify high-risk dAVF allowing closer surveillance or preventive interventions.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144673895","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":"Elevated Monocyte-to-Lymphocyte Ratio at Peritoneal Dialysis Initiation Predicts Long-Term Peritonitis Risk: A Retrospective Cohort Study.","authors":"Lin Zhang, Li Wang, Xiaotian Jiang, Xiaoxiao Yang, Xiaofang Yu, Jun Ji, Wuhua Jiang, Xiaoqiang Ding","doi":"10.1159/000547399","DOIUrl":"10.1159/000547399","url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD)-associated peritonitis is a major complication in PD patients, leading to increased morbidity and technique failure. Identifying reliable biomarkers for predicting peritonitis risk is crucial for early intervention. Monocyte-to-lymphocyte ratio (MLR) is an emerging inflammatory marker associated with adverse outcomes in end-stage renal disease, but its predictive value for peritonitis remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included PD patients from a single center who had undergone PD for at least 3 months. MLR was assessed at the time of PD catheter insertion, and patients were followed for 36 months. Peritonitis was defined according to the International Society for Peritoneal Dialysis criteria. Cox proportional hazards models were used to analyze the association between MLR (continuous and tertile-based) and peritonitis, adjusting for demographic, clinical, and laboratory factors. Restricted cubic spline (RCS) regression was applied to evaluate nonlinearity, and subgroup analysis was conducted to examine whether the association between MLR and peritonitis was consistent across different subgroups.</p><p><strong>Results: </strong>A total of 108 patients were included, with 33 (30.6%) developing peritonitis. MLR was significantly higher in the peritonitis group (p = 0.032). Cox regression showed that higher MLR was independently associated with an increased risk of peritonitis (adjusted hazard ratio = 1.85, 95% confidence interval: 1.01-3.40, p = 0.048). Patients in the highest MLR tertile had a sixfold increased peritonitis risk compared to those in the lowest tertile (p for trend = 0.002). RCS analysis revealed a nonlinear association, with a threshold at natural logarithm-transformed MLR = -0.9. Subgroup analysis suggested a stronger association in patients with lower body mass index (<24 kg/m2).</p><p><strong>Conclusion: </strong>Higher MLR at PD initiation is an independent predictor of long-term peritonitis risk. MLR may serve as a simple, cost-effective biomarker for early peritonitis risk stratification, particularly in leaner patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636054","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":"Comparison of Physical Function in Hemodialysis Patients Treated with Medium Cut-Off Dialyzers, High-Flux Dialyzers, and Hemodiafiltration.","authors":"Gizem Kumru, Busra Haktaniyan, Kenan Ates, Sehsuvar Erturk, Gokhan Nergizoglu, Kenan Keven, Sule Sengul, Sim Kutlay","doi":"10.1159/000546941","DOIUrl":"10.1159/000546941","url":null,"abstract":"<p><strong>Introduction: </strong>All dialysis modalities can potentially improve physical activity levels and patient well-being, primarily through better toxin clearance. We sought to assess the impact of medium cut-off hemodialysis (MCO-HD), high-flux hemodialysis (HF-HD), and high-flux hemodiafiltration (HF-HDF) on quantitative physical performance measures, which are prognostic for quality of life and mortality risk.</p><p><strong>Methods: </strong>Ten maintenance hemodialysis patients received MCO-HD, HF-HD, and HF-HDF, each for a duration of 6 months. Outcomes encompassed alterations in physical activity levels, assessed with the International Physical Activity Questionnaire, and physical performance, evaluated through the 5-times sit-to-stand, 4-meter gait speed, grip strength tests, and bioelectrical impedance analysis.</p><p><strong>Results: </strong>The cohort comprised 7 men and 3 women with a median dialysis vintage of 96 months (IQR: 36). Dialysis adequacy (single-pool KtV ≥1.2) was attained across all modalities for 18 months, with no notable alterations in nutritional and inflammation markers, including serum albumin. Self-reported physical activity improved during MCO-HD (total MET min/week 234.5 [IQR: 1,188] vs. 1,229.5 [IQR: 1,683], p = 0.019). There were no significant changes in handgrip strength, gait speed, or muscle mass in either group, nor were there any notable differences between the groups. The 5-times sit-to-stand test has shown stability in the MCO-HD group, whereas a substantial enhancement over 6 months observed with the HF-HDF (12.34 [IQR: 3.88] vs. 10.18 [IQR: 3.14] seconds, p = 0.022]).</p><p><strong>Conclusion: </strong>The MCO-HD group reported elevated physical activity levels, while the HF-HDF group demonstrated considerable enhancement in low extremity strength. The patient-centered selection of dialysis modality, including the implementation of exercises and nutritional interventions, may improve physical performance and patient outcomes.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotoxin and Cytokine Removal with a New (CA) Sorbent Cartridge.","authors":"Anna Lorenzin, Natascha Perin, Massimo de Cal, Monica Zanella, Claudio Ronco","doi":"10.1159/000547419","DOIUrl":"10.1159/000547419","url":null,"abstract":"<p><strong>Introduction: </strong>Endotoxin, also referred to as lipopolysaccharide (LPS), is a major stimulus of the inflammatory response capable of leading to sepsis and septic shock. Extracorporeal blood purification therapies are increasingly employed in the treatment of sepsis. Timely and thorough removal of endotoxin and cytokines can help mitigate the inflammatory cascade during septic shock. Hemoadsorption (HA) is a promising approach to achieve this goal. In this study, we analyzed different prototypes of a new CA cartridge: we performed in vitro circulations to define endotoxin and cytokine removal capacity.</p><p><strong>Methods: </strong>In vitro HA was performed using GALILEO testing platform, and customized circuits with mini-modules of CA cartridge were prepared. A batch of 500 mL of blood preconditioned with LPS was utilized for each circulation. We collected samples at different time points: endotoxin activity and removal ratio (RR) of LPS, interleukin 6 (IL-6), and interleukin-1 beta (IL-1β) were assessed.</p><p><strong>Results: </strong>The prototypes showed different performances, highlighting promising adsorption affinity toward the target molecules. A potentially clinically meaningful reduction of endotoxin activity by CA mini-module was observed. Concentration of the LPS, and cytokines IL-6 and IL-1β showed a significant reduction over time, as confirmed by the RRs.</p><p><strong>Conclusion: </strong>Our experiments allowed to characterize the prototypes in terms of adsorption capacity for both endotoxin and cytokines. After this preliminary approach, the final CA mini-module was tested under the same experimental conditions and displayed excellent adsorption capacity, indicating its potential application for endotoxin removal.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"The Goldilocks Challenge\": CRRT Capacity Building in Small- and Mid-Sized Pediatric ICUs.","authors":"Amrit Kirpalani, Hannah Gregor, Valérie Takahashi, Hannah Yassine, Cory Alec Manzo Anderson","doi":"10.1159/000547400","DOIUrl":"10.1159/000547400","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-4"},"PeriodicalIF":1.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636052","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 Use of Hemoadsorption in Cancer-Related Complications.","authors":"Vedran Premuzic, Lui G Forni","doi":"10.1159/000547348","DOIUrl":"10.1159/000547348","url":null,"abstract":"<p><strong>Background: </strong>Patients with metastatic cancer are at risk of drug-related toxicity or disease-related complications leading to the development of organ failure such as rhabdomyolysis-associated acute kidney injury (AKI), liver failure, and multi-organ failure, often precipitated by endotoxinemia and sepsis. In cases of systemic hyperinflammatory response, mediated by cytokines, to specific treatment with CAR-T-cell therapy or in sepsis with or without the development of AKI, we do not have an effective and specific target molecule-oriented therapy.</p><p><strong>Summary: </strong>Over the past few decades, numerous experimental and clinical studies have investigated the efficacy of extracorporeal blood purification technologies in the treatment of specific indications like sepsis and septic shock. In this review article, our goal was to show the possibility of using different hemoadsorbers in specific indications in patients with cancer-related complications, their reported effectiveness in certain indications and the possibility of applying it to cancer patients not only as a last-stand therapy but as well as preventing the development of specific organ or multi-organ failure.</p><p><strong>Key messages: </strong>Currently, multiple forms of extracorporeal blood purification are available that may have benefit in patients with cancer-related complications. Despite a strong rationale for extracorporeal blood purification, many physicians are still reluctant introducing hemoadsorption as a recommended routine due to still insufficient evidence, mostly as a result of inadequate numbers of published randomized controlled trials. Nevertheless, the application of hemoadsorption should be the same for cancer-related complications as well as it is for other patients because, in most cases, we aim to remove the same target molecules.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607210","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}