Blood Purification最新文献

{"title":"Development and Validation of a Coagulation Risk Prediction Model for Anticoagulant-Free Hemodialysis: Enhancing Hemodialysis Safety for Patients.","authors":"Shufan Chen, Yun Chen, Wei Zhang, Haihan Li, Zining Guo, Keyu Ling, Xiaoli Yu, Fei Liu, Xiaoping Zhu","doi":"10.1159/000542422","DOIUrl":"10.1159/000542422","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to develop and validate a risk prediction model for predicting the likelihood of coagulation in patients undergoing anticoagulant-free hemodialysis (HD). Anticoagulant-free HD technique is necessary in patients with contraindications to systemic therapy. Coagulation is a complication of this technique. Unfortunately, no predictive model is currently available to assess the risk of coagulation in anticoagulant-free HD.</p><p><strong>Methods: </strong>We retrospectively analyzed the clinical data from 299 HD sessions involving 164 patients who underwent anticoagulant-free HD between January 2022 and June 2023. To identify the risk factors for coagulation in anticoagulant-free HD, a univariate analysis was performed on 18 independent variables. Logistic regression was used to establish predictive models by identifying factors contributing to coagulation in anticoagulant-free HD. A calibration curve was drawn using regression coefficients and 1,000 bootstrap repetitions to validate our model internally. The performance of the prediction model was evaluated using receiver operating characteristic, area under the curve (AUC), and decision curve analysis (DCA).</p><p><strong>Results: </strong>The incidence of coagulation in patients on anticoagulant-free HD was 35.1%. Logistic regression analysis showed that platelet (PLT), hematocrit (HCT) levels, dialysate type, and age were risk factors for coagulation in anticoagulant-free HD patients (p < 0.05). The Hosmer-Lemeshow test showed p = 0.29, and the AUC is 0.76 (95% CI 0.70-0.80). The optimal critical value was 0.40, yielding a sensitivity of 61.0%, a specificity of 80.4%, and a Youden index of 0.41.</p><p><strong>Conclusion: </strong>In anticoagulant-free HD, there were numerous risk factors and a 35.1% occurrence of coagulation. The constructed coagulation risk prediction model exhibited good predictive and clinical utility and could serve as a reference for the initial assessment and screening of coagulation risk in anticoagulant-free HD.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674960","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":"Severely Hyperammonemic Acute Liver Failure due to Paracetamol Overdose: The Impact of High-Intensity Continuous Renal Replacement Therapy.","authors":"Anis Chaba, Stephen Joseph Warrillow, Caleb Fisher, Sofia Spano, Akinori Maeda, Atthaphong Phongphithakchai, Nuttapol Pattamin, Yukiko Hikasa, Nuanprae Kitisin, Scott Warming, Claire Michel, Glenn M Eastwood, Rinaldo Bellomo","doi":"10.1159/000542556","DOIUrl":"10.1159/000542556","url":null,"abstract":"<p><strong>Introduction: </strong>Paracetamol (acetaminophen)-induced acute liver failure (ALF) with severe hyperammonemia (ammonia >100 µmol⋅L-1) is a life-threatening condition. A strategy based on high-intensity continuous renal replacement therapy (CRRT) without early (up to day seven) transplantation may enable clinicians to safely identify which patients can recover and survive and which patients require transplantation.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective cohort study of patients with severely hyperammonemic paracetamol-induced ALF. The primary outcome was early transplant-free survival.</p><p><strong>Results: </strong>We studied 84 patients (median age: 38; female sex: 79 [85%]) over a 12-year period (median ammonia level at ICU admission: 153 µmol⋅L-1; median peak aspartate aminotransferase (AST): 10,029 U⋅L-1; median lactate: 5.0 mmol⋅L-1; and median INR: 4.4) and 55 (65%) with King's College criteria for transplantation. Overall, 87% received high-intensity CRRT (92% in 2020-2023). Median CRRT intensity was 54 mL⋅kg-1⋅hr-1 within the first 48 h and increased by 1.8 mL⋅kg-1⋅hr-1 per year during the study period (p = 0.002). Transplant-free survival to day 7 was 86% in 2011-2023 and 96% in 2020-2023. Overall, only 4 patients were transplanted and only 1 (4%) in 2020-2023. On multivariable Cox analysis, factors independently associated with failure to achieve day seven transplant-free survival were higher APACHE III score (HR = 1.05, 95% CI: 1.02-1.08), higher lactate (HR = 1.27, 95% CI: 1.12-1.44), and lower platelet count at ICU admission (HR = 0.85, 95% CI: 0.78-0.93) and the median effluent dose applied within the first 48 h of ICU admission (HR = 0.67, 95% CI: 0.46-0.98).</p><p><strong>Conclusions: </strong>Early transplant-free survival is achievable in most patients with paracetamol-induced ALF and severe hyperammonemia with a treatment based on high-intensity CRRT. Such transplant-free survival increased over time together with increased CRRT dose.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674964","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":"Intravenous Amino Acids: The Key to Perioperative Kidney Protection?","authors":"Faeq Husain-Syed, John A Kellum, Claudio Ronco","doi":"10.1159/000542333","DOIUrl":"10.1159/000542333","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674962","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":"Albumin and Platelet Loss during the Application of CytoSorb® in Critically Ill Patients: A post hoc Analysis of the Cyto-SOLVE Trial.","authors":"Clara Isabell Brozat, Michael Zoller, Sandra Frank, Mathias Bruegel, Caroline Gräfe, Diana Rebholz, Michael Paal, Helen Graf, Uwe Liebchen, Christina Scharf","doi":"10.1159/000542009","DOIUrl":"10.1159/000542009","url":null,"abstract":"<p><strong>Introduction: </strong>Adsorption devices like CytoSorb® (CS) are increasingly used in critically ill patients. However, potential adverse effects have not been sufficiently investigated. The aim of this post hoc analysis of the monocentric prospective Cyto-SOLVE study was to examine albumin concentration and platelet count during the application of CS in intensive care unit (ICU) patients with different indications for CS therapy.</p><p><strong>Methods: </strong>Twenty-nine adult ICU patients receiving continuous kidney replacement therapy and CS application for 12 h were included. Albumin concentration and platelet count were measured before, during, and after application. Changes in albumin concentration and platelet count were investigated. Since 10/29 patients were substituted with platelets during CS therapy and 20/29 received albumin, subgroup analysis was performed in patients receiving no platelet concentrate and <20 g albumin substitution during CS application. The dependent sample t test was used to detect significant (p < 0.05) changes over time, and multivariate models were investigated.</p><p><strong>Results: </strong>We observed a significant reduction in platelets (p = 0.005, mean 14 G/L, 95% confidence interval (CI) 4-23 G/L) during CS therapy with an even more pronounced drop in those 19 patients without platelet substitution (p = 0.001, mean 22 G/L, 95% CI 10-34). No significant change was detected in the albumin concentration of all patients. However, a significant albumin decrease was observed in those 17 patients with less than 20 g albumin substitution during CS therapy (p = 0.007, mean 0.17g/dL, 95% CI 0.05-0.29). No other potential covariates for the decrease could be identified in a multivariate model.</p><p><strong>Conclusion: </strong>Since a drop in albumin and platelets occurred during the use of CS, an increased substitution might be necessary. Knowledge of potential side effects is of great importance to prevent harm during the use of extracorporeal procedures. This knowledge should be considered for a reliable risk-benefit assessment in the future.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602854","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":"Use of Cardiac Troponin Assays in Hemodialysis Patients.","authors":"Michael Kolland, Peter P Rainer, Alexander H Kirsch","doi":"10.1159/000542336","DOIUrl":"10.1159/000542336","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575317","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":"First-In-Human Rapid Removal of Circulating Tumor Cells in Solid Metastatic Neoplasia by Microbind Affinity Blood Filter.","authors":"Sanja Ilic, Vedran Premuzic","doi":"10.1159/000542325","DOIUrl":"10.1159/000542325","url":null,"abstract":"<p><strong>Introduction: </strong>We conducted a first-in-human trial evaluating safety and the potential for combined pathogen and circulating tumor cell (CTC) removal in patients with solid metastatic cancers.</p><p><strong>Methods: </strong>The Seraph procedure was performed at a hemodialysis clinic on 10 consecutive patients with metastatic cancer whose liquid biopsy was positive for the epithelial cell adhesion molecule. All the patients exerted positive bacterial or fungal isolates.</p><p><strong>Results: </strong>We have demonstrated the ability of Seraph100® Filter to remove both pathogens and CTCs, with median reduction of 71% within 120 min, from patient blood.</p><p><strong>Conclusion: </strong>High-yield CTC clearance could potentially benefit patients in diagnostic and personalized treatment of cancer to be elucidated in further research.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-3"},"PeriodicalIF":2.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of Meropenem and Piperacillin during Experimental Hemoadsorption with the HA380 Cartridge.","authors":"Taku Furukawa, Yugeesh Lankadeva, Ian Baldwin, Pei Chen Connie Ow, Sally Hood, Antoine Schneider, Laurent A Decosterd, Clive N May, Rinaldo Bellomo","doi":"10.1159/000542332","DOIUrl":"10.1159/000542332","url":null,"abstract":"<p><strong>Introduction: </strong>Hemoadsorption can be used as adjunctive therapy for sepsis. However, there is limited evidence regarding its antibiotic removal. In this in vivo preclinical study, we aimed to evaluate the removal of meropenem and piperacillin with the HA380 hemoadsorption cartridge.</p><p><strong>Methods: </strong>Healthy adult sheep (n = 6) received 2 g of meropenem and 4 g of piperacillin intravenously for 30 min followed by hemoadsorption with a HA380 cartridge at a blood flow rate of 120 mL/min for 4 h. The sorbent-based removal ratio, clearance, and mass removal were calculated at multiple time points.</p><p><strong>Results: </strong>The sorbent-based removal ratio of meropenem decreased from 95.4% (SD 1.8) at 10 min to less than 20% at 4 h of hemoadsorption. Its cumulative sorbent-based mass removal was 386.6 mg (SD 78.8) over 4 h with 65.6% (SD 7.1) occurring in the first 60 min. In contrast, the sorbent-based removal ratio of piperacillin decreased more gradually from 98.4% (SD 0.6) at 10 min to 37.4% (SD 7.2) at 4 h. Its cumulative sorbent-based mass removal was 647.4 mg (SD 191.3) over 4 h with 63.4% (SD 4.2) occurring in the first 60 min. The overall sorbent-based clearance of piperacillin was significantly greater than meropenem (pgroup < 0.0001).</p><p><strong>Conclusion: </strong>Hemoadsorption with the HA380 cartridge removed meropenem and piperacillin throughout a 4-h period, with high clearances at the start. Our findings can be used to inform dosing decisions during hemoadsorption in septic patients, there may be the need to consider increasing the doses of these antibiotics by 15-25% to prevent underdosing.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction Rate of Uric Acid in Blood during Continuous Renal Replacement Therapy for Acute Kidney Injury: A Multicenter Retrospective Observational Study.","authors":"Yutaro Inoue, Ryota Inokuchi, Hidehiko Nakano, Yoshiki Masuda, Osamu Nishida, Kent Doi","doi":"10.1159/000542329","DOIUrl":"10.1159/000542329","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous renal replacement therapy (CRRT) eliminates these small solutes with equal efficacy under the same conditions. However, variations in the reduction rates of these solutes observed in patients with CRRT are likely influenced by factors other than removal through CRRT. This study evaluated the reduction rates of these small solutes during CRRT and their possible association with mortality.</p><p><strong>Methods: </strong>This study used the data of limited patients registered in the CHANGE study, which is a large retrospective observational study on CRRT management across 18 Japanese ICUs. Reduction rates of three solutes in blood, calculated on the 1st and 2nd days, were compared in patients with acute kidney injury (AKI) treated by CRRT. The potential association between solute reduction rates and mortality during CRRT or within 7 days after the termination of CRRT was evaluated.</p><p><strong>Results: </strong>In total, 163 patients with AKI were included in the analysis. The reduction rates of uric acid (UA) were significantly higher than those of urea and creatinine for the 1st and 2nd tests in the entire cohort. Receiver operating characteristic (ROC) curve analysis revealed that lower UA reduction rates were significantly associated with mortality during CRRT or within 7 days after CRRT termination {area under the ROC curve: 0.62 [95% confidence interval (CI): 0.52-0.71] for the 1st test and 0.63 [95% CI: 0.54-0.72] for the 2nd test}. After adjusting for age and SOFA score, a significant association was observed between lower UA reduction rates and hospital mortality for both tests.</p><p><strong>Conclusion: </strong>Among the small solutes, UA reduction rates in patients with AKI treated with CRRT were notably higher than those of creatinine and urea. Furthermore, the significant association between lower UA reduction rates and mortality suggests that UA reduction rate may serve as a valuable indicator of insufficient removal of uremic solutes by CRRT, although the decline in UA production must be taken into account.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543345","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":"Is endovascular arteriovenous fistula a feasible alternative for hemodialysis patients?","authors":"Hugo Vergara-Pérez,Raúl Diaitz-Usetxi Laplaza,Alejandro Pérez Alba,Pablo Baliño Remiro,Asunción Rius Peris,M Ángeles Fenollosa Segarra,Alejandro Tamayo Vasquez,Javier Reque","doi":"10.1159/000541233","DOIUrl":"https://doi.org/10.1159/000541233","url":null,"abstract":"INTRODUCTIONFor hemodialysis (HD) patients, the selection of vascular access (VA) is a crucial factor that significantly affects morbidity and mortality. Historically, native Arteriovenous Fistulas (AVFs) have been established using surgical techniques. However, devices facilitating percutaneous endovascular arteriovenous fistula formation have recently been introduced in clinical practice, showing promising initial evidence. The primary objectives were technical success, efficacy, and cannulation rates. The secondary objectives included primary and cumulative patency, safety, and the number of procedures required to maintain fistula patency.METHODSA prospective, single-center, single-arm study that included all patients who underwent endovascular arteriovenous fistulas (endoAVF) creation using the WavelinQ™ EndoAVF System at a University Hospital between December 2021 and August 2023.RESULTSA total of 20 patients who underwent an endoAVF were included. Technical success was 100%. 75% (15) of the endoAVFs met the criteria for physiological suitability. The cannulation rate was 66% (10/15) for endoAVFs that reached physiological suitability. At 6 months of follow-up, the primary and cumulative patency rates were 65% and 75%, respectively; at 12 months, these were 50% and 70%, respectively. Serious adverse events were not observed. The reintervention rate was 0.33 procedures/patient-year.CONCLUSIONBased on our experience, creating AVFs using the WavelinQ 4-F EndoAVF system is safe and effective, with high technical success rates and acceptable patency and reintervention rates.","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":"1 1","pages":"1-15"},"PeriodicalIF":3.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260782","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 hypophosphatemia during continuous kidney replacement therapy and clinical outcomes: a systematic review and meta-analysis.","authors":"Lu Jin,Peiyun Li,Qing Xv,Linshen Xie,Ling Zhang","doi":"10.1159/000541423","DOIUrl":"https://doi.org/10.1159/000541423","url":null,"abstract":"INTRODUCTIONHypophosphatemia is a common and potentially severe complication of continuous kidney replacement therapy (CKRT), but the evidence on the correlation between hypophosphatemia occurring during CKRT and clinical outcomes remains limited.METHODSElectronic databases (PubMed, Embase, Web of Science, and the Cochrane database) were searched from inception to March 1, 2024. All possible studies that examined the following outcomes were included: all-cause mortality, mechanical ventilation, intensive care unit (ICU) stay, and CKRT duration.RESULTSA total of 8,631 patients from eight cohort studies were included. There was no statistical association between hypophosphatemia during CKRT and all-cause mortality in critically ill patients (OR 0.82, 95% CI 0.57-1.18, P =0.28, I2 = 83%). However, hypophosphatemia was associated with longer duration of mechanical ventilation (WMD 80.30h, 95% CI 31.37-129.22, P =0.001, I2 = 60%). Furthermore, a longer length of ICU stay (WMD 2.76d, 95% CI 2.50-3.02, P &lt;0.00001, I2 = 36%) and CKRT duration (WMD 51.51h, 95% CI 2.69-100.34, P =0.04, I2 = 96%) were observed in patients with hypophosphatemia.CONCLUSIONSThe association between hypophosphatemia and mortality in patients receiving CKRT was insufficient. However, hypophosphatemia during CKRT might be associated with adverse clinical outcomes for critically ill patients.","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":"47 1","pages":"1-18"},"PeriodicalIF":3.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260783","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}