Blood Purification最新文献

{"title":"Influence of Different Hemodialysis Biocontrols on the Achievement of the Convective Volume.","authors":"Patricia Muñoz Ramos, Laura Guasch, David Conejo, Esther Rodríguez, Virginia López, Borja Quiroga, Mayra Ortega, Rafael Lucena, Marta Puerta, Laura Medina, Fabio Luca Procaccini, Juan Martín-Navarro, Roberto Alcázar, Patricia de Sequera","doi":"10.1159/000546642","DOIUrl":"10.1159/000546642","url":null,"abstract":"<p><strong>Introduction: </strong>Post-dilution on-line hemodiafiltration (OL-HDF) has been shown to reduce all-cause mortality in hemodialysis (HD) patients when high substitution volumes are achieved. To date, little emphasis has been placed on the impact of different biocontrols in achieving high replacement volumes. The aim of the present study was to compare the substitution volume achieved with three different monitors using the three available automatic systems.</p><p><strong>Methods: </strong>Prospective, observational cross-over study of prevalent patients on post-dilution OL-HDF. Each patient underwent 9 consecutive post-dilution OL-HDF sessions with each of the monitors included in the study: Artis, 6008, and Surdial X with the corresponding biocontrols: UltraControl, AutoSub+, and Max-Sub, respectively. After each session, the final convective volume and other parameters related to HD and medium-molecule clearance were collected.</p><p><strong>Results: </strong>Thirteen patients were included (57% male, age 62 ± 14 years), of whom 71% were dialyzed via an arteriovenous fistula. The mean time on dialysis was 51 ± 32 months. Convective volume achieved with Max-Sub biocontrol (Surdial X monitor) was higher than that achieved with UltraControl biocontrol (Artis monitor) (31 ± 2 vs. 29.4 ± 2.2 L/session, p = 0.009) and AutoSub+ biocontrol (6008 monitor) (31 ± 2 vs. 28.9 ± 2.6 L/session, p = 0.01). On multivariate analysis, factors associated with higher convective volume were the prescription of Max-Sub biocontrol (B 1.61, 95% CI [0.41-2.80], p = 0.009), TPM (B 0.02, 95% CI [0.01-0.03], p = 0.018), blood processed (B 0.17, 95% CI [0.08-0.26], p < 0.001), and not having diabetes mellitus (B -1.66, 95% CI [-2.72 to 0.59], p = 0.002).</p><p><strong>Conclusion: </strong>The volume achieved by convective transport can vary according to the type of biocontrol, with Max-Sub performing the best out of the 3 biocontrol systems.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-10"},"PeriodicalIF":1.8,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582971","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":"Effect of Different Dialysate Sodium Concentrations on Blood Pressure in Chronic Haemodialysis Patients: A Randomized Study.","authors":"Luka Varda, Nejc Piko, Sebastjan Bevc, Radovan Hojs, Robert Ekart","doi":"10.1159/000546469","DOIUrl":"10.1159/000546469","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is associated with higher cardiovascular morbidity and mortality in chronic haemodialysis patients. Altering dialysate sodium (dNa) concentration presents a possibility of sodium balance control and blood pressure (BP) management.</p><p><strong>Methods: </strong>We performed a prospective, randomized, single-centre study, including 45 patients, divided into three groups of 15. Each group went through 3 periods of 2 months. The first group started with a dNa of 138 mmol/L in the first period, 140 mmol/L in the second, and 142 mmol/L in the third. The third group completed the study with the opposite dNa alteration (reduction from 142 to 138 mmol/L). The second group continued with 140 mmol/L throughout the study.</p><p><strong>Results: </strong>In the first group, we found a statistically significant reduction of pre-dialysis systolic BP in the first period, compared with BP values before the study and a significant increase in pre-dialysis diastolic BP in the second period. Upon reduction of dNa from 140 to 138 mmol/L in the third group, the reduction of pre-dialysis systolic BP was approaching statistical significance. We did not find significant differences in BP values or the presence of hypotension between groups in each period. In the first group, we recorded a significant decrease in interdialytic weight gain and ultrafiltration volume in the first period and an increase in these parameters in the second. We were unable to reach a significant reduction in the latter after lowering dNa in the third group.</p><p><strong>Conclusion: </strong>This study offers limited support for the idea that small reductions in fixed dNa (2 mmol/L) significantly change peri-dialytic BP values.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-14"},"PeriodicalIF":1.8,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144558932","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":"Regional Practice Variation in the Management of Renal Replacement Therapy Modalities in the STARRT-AKI Trial.","authors":"Rinaldo Bellomo, Ron Wald, Sean M Bagshaw, Ary Serpa Neto","doi":"10.1159/000547141","DOIUrl":"10.1159/000547141","url":null,"abstract":"<p><strong>Introduction: </strong>The assess whether, in high-income countries, in the STandard vs. Accelerated initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial, the management of the chosen initial renal replacement therapy modality varied by region and whether such variation was associated with different outcomes.</p><p><strong>Methods: </strong>Post hoc analysis of the STARRT-AKI trial, including 142 ICUs in 13 countries. We evaluated 1,395 patients with severe AKI from North America, Europe, and Australia-New Zealand (ANZ) who received continuous renal replacement therapy (CRRT) as a first modality and 684 patients from North America and Europe who received intermittent hemodialysis (IHD) as a first modality.</p><p><strong>Results: </strong>Among CRRT-first patients, femoral vascular access (p < 0.001) and citrate anticoagulation were more common in Europe and ANZ (p < 0.001) before and after adjustment for baseline characteristics. Treatment in ANZ was independently associated with a more negative fluid balance (p = 0.029), less frequent transition to IHD (p = 0.040), and lower CRRT dose-intensity (p = 0.012). Among IHD-first patients, compared to Europe, treatment in North America was independently associated with less use of femoral access, and greater net ultrafiltration rate.</p><p><strong>Conclusion: </strong>At STARRT-AKI trial centers, there was significant region-dependent practice variation in the management of CRRT-first and IHD-first patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-17"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538037","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":"Rinaldo Bellomo, MD (1956-2025).","authors":"John A Kellum, Ravindra Mehta, Claudio Ronco","doi":"10.1159/000547078","DOIUrl":"https://doi.org/10.1159/000547078","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538038","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":"Rinaldo Bellomo, MD (1956-2025).","authors":"John A Kellum, Ravindra Mehta, Claudio Ronco","doi":"10.1159/000547078","DOIUrl":"https://doi.org/10.1159/000547078","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-5"},"PeriodicalIF":2.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144504813","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":"A Comparison of Clinical Outcomes in Urgent-Start Hemodialysis versus Urgent-Start Peritoneal Dialysis in End-Stage Renal Disease Patients: A Systematic Review and Meta-Analysis.","authors":"Jia Wu, Yifu Cao, Tianzhi Wang","doi":"10.1159/000547049","DOIUrl":"10.1159/000547049","url":null,"abstract":"<p><strong>Introduction: </strong>Current evidence indicates that for patients requiring renal replacement therapy, USPD may correlate with reduced complications and lower mortality rates compared to USHD. However, there is a lack of literature specifically addressing its application and results in individuals with ESRD. A comprehensive examination and synthesis of existing research were conducted to compare fellow-up outcomes of USPD versus USHD in ESRD patients.</p><p><strong>Methods: </strong>A comprehensive search was conducted in PubMed, Web of Science, and the Cochrane Library, and SpringerLink databases for that compare USPD to USHD before November 1, 2024. Mortality, all complications, noninfectious complications, infectious complications, bacteremia, and peritonitis were used as outcomes to compare USPD and USHD.</p><p><strong>Results: </strong>This meta-analysis incorporated seven studies involving a total of 1,338 patients. Our findings showed no notable distinctions in peritonitis between USPD and USHD. urgent-start PD was linked to a reduced mortality rate \"(OR: 0.48, 95% CI: 0.24-0.95, p < 0.05), lower all complications (OR: 0.27, 95% CI: 0.20-0.37, p < 0.05), lower noninfectious complications (OR: 0.32, 95% CI: 0.23-0.45, p < 0.05), lower infectious complications (OR: 0.29, 95% CI: 0.17-0.51, p < 0.05), lower bacteremia (OR: 0.18, 95% CI: 0.07-0.42, p < 0.05)\" compared to USHD.</p><p><strong>Conclusions: </strong>Our findings indicate that among patients with ESRD, those undergoing urgent-start PD have lower risks during the follow-up period compared to those receiving USHD. USPD is associated with significantly reduced all-cause mortality, overall complications, infectious complications, noninfectious complications, and bacteremia incidence. The results indicate that USPD could potentially function as an appropriate replacement for USHD. However, further high-quality clinical studies still are necessary to substantiate this conclusion.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-11"},"PeriodicalIF":1.8,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483098","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 Immunomodulatory Potential of Hemoadsorption in Burn Care.","authors":"Nicolas Chardon, Frank Bidar, Paul Samuel Abraham, Céline Monard, Kevin K Chung, Thomas Rimmelé","doi":"10.1159/000547001","DOIUrl":"10.1159/000547001","url":null,"abstract":"<p><strong>Background: </strong>Burns are a common injury affecting thousands of people worldwide each year. Clinical severity varies according to the total body surface area burned, which is in turn associated with morbidity and mortality. The management of a severe burn patient requires admission to a referral center. Patients with severe burns exhibit a complex and dysregulated immuno-inflammatory response. This leads to the loss of immune homeostasis, which is a source of infectious complications and organ dysfunctions. This loss of control of immune mechanisms plays a key role in the morbidity and mortality of severe burn patients.</p><p><strong>Summary: </strong>Currently, several strategies, such as hemoadsorption, have been developed to modulate this host response. Modern hemoadsorption is based on new highly biocompatible sorbent cartridges of neutral macroporous resin beads. We propose herein a review of the immune pathways in burn injury and the rationale and potential applications of extracorporeal blood purification techniques, such as hemoadsorption, in the management of burn patients.</p><p><strong>Key messages: </strong>Severe burns trigger an uncontrolled immuno-inflammatory response, leading to high morbidity and mortality. Immune homeostasis loss is central to complications such as infections and organ failure. Hemoadsorption may represent a potential therapeutic option to help modulate the immune response in burn patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-9"},"PeriodicalIF":2.2,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144483099","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":"J-Shaped Relationship of the Triglyceride-Glucose Index with All-Cause Mortality in Initial Hemodialysis Patients in China: A Multicenter, Retrospective Cohort Study.","authors":"Shi-Mei Hou, Zhong-Tang Li, Tian-Ke Yu, Min Li, Yao Wang, Min Yang, Jing-Ting Jiang, Li-Rong Hao, Jian-Bing Hao, Feng-Ming Dong, Min Yang, Jing Zheng, Jing-Jie Xiao, Xiao-Liang Zhang, Bi-Cheng Liu, Jing-Yuan Cao, Bin Wang","doi":"10.1159/000546704","DOIUrl":"10.1159/000546704","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between the triglyceride-glucose (TyG) index and mortality in hemodialysis patients remains uncertain. This study aimed to investigate the correlation between TyG index and all-cause mortality in initial hemodialysis patients in China.</p><p><strong>Methods: </strong>783 patients participated in the study and were grouped into quintiles according to the TyG index. Multivariate Cox models and subgroup analyses were utilized. Nonlinear correlations were explored using restricted cubic splines, and a two-piecewise Cox proportional hazards model was developed around the inflection point.</p><p><strong>Results: </strong>During a median follow-up of 44 months, 231 (29.50%) patients occurred mortality. Multivariate Cox regression confirmed that both lower and higher TyG indices independently predicted all-cause mortality (all p < 0.05). The predictive value of a high TyG index for all-cause mortality remained consistent across age, sex, BMI, and diabetes subgroups. A restricted cubic spline unveiled a J-shaped relationship between the two variables in initial hemodialysis patients. A TyG index exceeding 8.83 exhibited a positive correlation with all-cause mortality (hazard ratio, 1.78; 95% CI: 1.27-2.46, p < 0.001).</p><p><strong>Conclusions: </strong>A J-shaped relationship was identified between the TyG index and all-cause mortality in initial hemodialysis patients in China, with a threshold of 8.83 for all-cause mortality.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-14"},"PeriodicalIF":1.8,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324444","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, Virus, and Bacterial Removal: Why, When, and How?","authors":"Lui G Forni, Vedran Premuzic","doi":"10.1159/000546923","DOIUrl":"10.1159/000546923","url":null,"abstract":"<p><strong>Background: </strong>Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, and where underlying circulatory, cellular, and metabolic abnormalities contribute to a greater risk of mortality than that posed by sepsis alone, this may be considered septic shock where circulatory support is needed in the face of a raised lactate level. The main pillars of therapy remain source control and appropriate timely antibiotics, resuscitation where needed, and adequate source control. However, in the setting of organ failure further support may be needed.</p><p><strong>Summary: </strong>Here, we discuss the potential benefits from removal of pathogens using available extracorporeal techniques. Although randomized controlled trials supporting such an approach remain elusive, this is due to change in the next few years with current studies being performed. The use of extracorporeal blood purification therapies is a promising therapeutic strategy for critically ill ICU patients with high pathogen load refractory to conservative treatment or with elevated endotoxin levels.</p><p><strong>Key messages: </strong>By targeting specific inflammatory mediators and pathogens, extracorporeal blood purification can help mitigate the severe inflammatory response associated with sepsis which should translate into improved patient survival. This approach may be particularly beneficial in cases where traditional treatments fail highlighting the need for further data to optimize the use of blood purification therapies in sepsis management.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-8"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Venous Chamber Design in CRRT: Implications for Reducing Clot Risk and Enhancing Circuit Longevity.","authors":"Minmin Wang","doi":"10.1159/000546913","DOIUrl":"10.1159/000546913","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324445","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}