Blood Purification最新文献

{"title":"Innovative Solution for Treating Hypervolemia in Patients with End-Stage Renal Disease.","authors":"Abdelaziz Sidi Baba, Hasnae Zahim, Rim El Azrak, Abdellah Boualam, Abdellah Ait Taleb, Benyounès Ramdani, Mohamed Zamd","doi":"10.1159/000545121","DOIUrl":"10.1159/000545121","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload (FO) is a prevalent and serious complication of end-stage chronic kidney disease (ESRD). Its most dramatic manifestation is acute and life-threatening pulmonary edema. It is also associated with a high rate of morbidity and mortality in these patients. On the other hand, maintaining a state of hydration and optimal volume in these patients remains the major challenge of renal replacement therapies. We report an emerging technological approach to achieve \"fluid neutrality\" in patients with ESRD. It is a portable and intelligent ultrafiltration device called MorWAK (Moroccan Wearable Artificial Kidney). It was designed to detect, quantify, and treat daily FO using the principle of ultrafiltration through a semi-permeable membrane. Its operating principle is based on the use of accordion-shaped suction bellows, already used in surgery, as an ultrafiltration pump. The two aims of this study were to explore the functioning of the suction bellows (establishment of a mathematical equation) and to test the performance of MorWAK in vitro using bovine whole blood.</p><p><strong>Methods: </strong>The first part of the study involved measuring the pressure within the bellows as a function of the volume added after depression at the start of the experiment. The second part consisted of five ultrafiltration sessions on bovine whole blood bags. The blood pump was set to a constant flow rate of 120 mL/min. Blood pressure was kept constant, at approximately 80 mm Hg, during the five experiments by positioning the blood bag at 50 cm height. In all our experiments, we used a polyethersulfone membrane of 1 m2 and a standard suction bellows of 800 mL capacity. Ultrafiltration was compensated by concomitant controlled saline infusion.</p><p><strong>Results: </strong>The equation describing the evolution of pressure inside the suction bellows as a function of the volume it received was P<sub>i</sub> = P<sub>0</sub> [1 - ln (V<sub>i</sub>)/ln (V<sub>0</sub>)]. P<sub>i</sub> is the pressure inside the suction bellows at a time t, V<sub>i</sub> is the volume of saline solution inside the suction bellows at the time t, P<sub>0</sub> is the maximum depression reached during the contraction of the suction bellows, and V<sub>0</sub> is the volume of the bellows at rest (ln: natural logarithm). In the second part of the study, the pressure inside the suction bellows had the same profile as during the previous experiment (logarithmic curve) up to the zero value (0 mm Hg). Then, it followed a linear curve parallel to the accumulation of the liquid by ultrafiltration in the suction bellows. When the blood pressure and the pressure inside suction bellows became equal, the ultrafiltration stopped. The mean final ultrafiltered volume was 854.23 ± 95.12 mL during a mean session duration of 28.33 ± 7.85 min. The mean difference between this volume and the theoretical volume calculated based on transmembrane pressure (TMP), ultrafiltrati","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"437-446"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172425","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":"Selected Abstracts from the 43rd Vicenza Course AKI-CRRT-EBPT and Critical Care Nephrology.","authors":"Gioia Vencato","doi":"10.1159/000547992","DOIUrl":"10.1159/000547992","url":null,"abstract":"<p><p>Selected Abstracts from the 43rd Vicenza Course AKI-CRRT-EBPT and Critical Care Nephrology.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":"54 Suppl. 1","pages":"1-91"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022787","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":"Urgent-Start Peritoneal Dialysis in Metformin-Associated Lactic Acidosis: A Critical Alternative when Immediate Hemodialysis Is Unavailable.","authors":"Watanyu Parapiboon, Jakkrid Banjong, Chirakhana Siangtrong, Theerapun Boonsayomphu, Wirayut Silakun","doi":"10.1159/000542003","DOIUrl":"10.1159/000542003","url":null,"abstract":"<p><strong>Introduction: </strong>Intermittent hemodialysis (IHD) is a preferable renal replacement therapy (RRT) option in metformin-associated lactic acidosis (MALA) due to rapid correct metabolic acidosis. However, IHD might not be started immediately. Immediate urgent-start peritoneal dialysis (iUSPD) is used as a life-saving dialysis option and then followed by IHD. The outcomes of iUSPD were compared with other extracorporeal dialysis in MALA.</p><p><strong>Methods: </strong>In two tertiary hospitals in Thailand, the outcomes of patients with MALA who had received three different RRT modalities (iUSPD followed by IHD, IHD, and continuous renal replacement therapy [CRRT]) from January 2015 to December 2019 were compared. The primary outcome was 30-day mortality. The secondary outcomes were door-to-dialysis time and 90-day RRT dependence.</p><p><strong>Results: </strong>A total of 180 MALA cases that required dialysis were included (20 iUSPD, 120 IHD, and 40 CRRT). Their mean age was 64 years. Most of the patients had severe metabolic acidosis (mean pH 6.91, HCO3 6 mmol/L, and anion gap 40 mmol/L) and were critically ill. The 30-day mortality was 30% in iUSPD, 9.2% in IHD, and 32.5% in CRRT (p = 0.001). The mortality risk in the iUSPD group was not significantly different from those of the IHD and CRRT groups (adjusted HR 2.5, 95% CI: 0.65-9.6, and adjusted HR 0.75, 95% CI: 0.2-2.78, respectively). All dialysis modalities had comparable 90-day dialysis dependence. iUSPD exhibited the shortest door-to-dialysis time.</p><p><strong>Conclusion: </strong>In MALA, iUSPD followed by IHD might be a viable RRT option to save patient lives if no other dialysis options are available.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"9-17"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457194","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":"Prevalence of Patent Processus Vaginalis Diagnosed Using Laparoscopy during Peritoneal Dialysis Catheter Insertion and Subsequent Genital Edema: A Prospective Observational Study.","authors":"Terumasa Hayashi, Susumu Miyazaki, Kazuhiro Iwase, Taisuke Takatsuka, Daisuke Yoshimura, Tomohiro Kawamura, Yukimasa Iwata, Hiroki Okushima, Yoshiyasu Ueda, Yoshitaka Isaka","doi":"10.1159/000542588","DOIUrl":"10.1159/000542588","url":null,"abstract":"<p><strong>Introduction: </strong>Inguinal hernia and genital edema are relatively common complications of peritoneal dialysis (PD). Although patent processus vaginalis (PV) is considered an important factor associated with these complications, the prevalence of patent PV at PD initiation and whether it leads to these complications has not been fully identified.</p><p><strong>Methods: </strong>A total of 71 patients were included in this study, 41 of whom underwent laparoscopy-assisted catheter placement. The remaining 30 patients did not undergo laparoscopy mainly because of a lack of patient consent. During laparoscopy, if a dimple or small canal toward the deep inguinal ring was observed, the groin was diagnosed as a patent PV.</p><p><strong>Results: </strong>Laparoscopy revealed that 9 of 41 patients (22%) had patent PV (male, 29.6%; female, 7.1%). Genital edema occurred in 2 of the nine patients with patent PV at 8.9 and 11.4 months after PD initiation, respectively. However, none of 32 patients without patent PV developed this complication. Two of 30 patients without laparoscopic inspection presented with genital edema at 6.7 and 12.4 months after PD initiation, respectively. Among the 71 patients, body mass index was significantly higher in patients with this complication than in those without (28.8 vs. 22.8, p 0.013).</p><p><strong>Conclusion: </strong>Although the number of patients with patent PV who manifested genital edema was small, our results suggest that patent PV at PD initiation may be an important contributor for genital edema in patients undergoing PD. Further studies are needed to determine whether the repair of patent PV could prevent subsequent genital edema.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"141-148"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765764","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 Safety and Efficacy in Pediatric Continuous Renal Replacement: The Promise of Diluted Regional Citrate Anticoagulation.","authors":"Minmin Wang, Wenxiong Li, Qiang Yao","doi":"10.1159/000546705","DOIUrl":"10.1159/000546705","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"533-534"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144233072","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":"In vitro Assessment of Drug Adsorption Profiles during Hemoadsorption Therapy.","authors":"Andreas Körtge, Christoph Kamper, Gerd Klinkmann, Reinhold Wasserkort, Steffen Mitzner","doi":"10.1159/000545120","DOIUrl":"10.1159/000545120","url":null,"abstract":"<p><strong>Introduction: </strong>The use of hemoadsorption devices is increasingly gaining impact as an adjunct therapy for various critical conditions in ICU patients, including systemic hyperinflammation, cytokine release syndrome, sepsis, and more. A key concern in this therapy is its impact on the plasma levels of concurrently administered drugs, which could potentially be reduced to subtherapeutic levels, affecting patient care. The present study investigates the adsorption behavior of various drugs in an in vitro hemoadsorption model using human whole blood, aiming to provide insights for optimizing drug dosing during hemoadsorption therapy.</p><p><strong>Methods: </strong>The study assessed the removal rates and clearances of several drugs, namely, apixaban, argatroban, carbamazepine, oxcarbazepine, lamotrigine, phenytoin, valproate, levosimendan, methylene blue, and metformin, by circulating the blood through CytoSorb adsorbers in an in vitro setup.</p><p><strong>Results: </strong>Significant removal (75 to 100% of the initial concentration) and high initial plasma clearances (approximately 10-25 mL/min) were observed for most of the tested drugs within the first 30-60 min of recirculation. Lower removal rates and clearances were noted for valproate (approximately 40% and 5 mL/min) and metformin (approximately 15% and 1 mL/min).</p><p><strong>Conclusion: </strong>The findings indicate considerable differences in the adsorption of the tested drugs and should be confirmed by additional in vivo studies with careful monitoring of drug levels throughout the course of therapy. Understanding the in vivo dynamics is crucial for adjusting dosages appropriately during hemoadsorption use to ensure therapeutic efficacy and patient safety.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"218-225"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombocytopenia in Children and Young Adults Undergoing Continuous Renal Replacement Therapy: A WE-ROCK Study.","authors":"Abby Basalely, Katja M Gist, Natalja L Stanski, Dana Y Fuhrman, JangDong Seo, Nicholas J Ollberding, Amy Strong, Mihaela Damian, Catherine Morgan, Stephanie Reynaud, Melissa Muff-Luett, Akash Deep, Carmela Serpe, Kelli A Krallman, Shina Menon","doi":"10.1159/000545777","DOIUrl":"10.1159/000545777","url":null,"abstract":"<p><strong>Introduction: </strong>Thrombocytopenia in patients treated with continuous renal replacement therapy (CRRT) in adults is associated with mortality. Pediatric data are limited. The association between pre-CRRT thrombocytopenia and platelet decline at 24 h of CRRT with outcomes was evaluated.</p><p><strong>Methods: </strong>Secondary analysis of the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) includes patients' birth-25 years who underwent CRRT. Exclusions were end-stage kidney disease, non-acute kidney injury/fluid overload CRRT indication, concurrent extracorporeal membrane oxygenation, missing baseline platelets, platelet disorders, and hematologic malignancy. Primary exposures were (i) pre-CRRT thrombocytopenia (≤100 × 103/μL) and (ii) ≥30% decline at 24 h of CRRT in those with pre-CRRT >100 × 103/μL. Primary outcome was survival to intensive care unit (ICU) discharge. Secondary outcomes included major adverse kidney events at 90 days (MAKE-90) (death, dialysis dependence, creatinine >125% baseline) from CRRT initiation.</p><p><strong>Results: </strong>A total of 805 patients were included. Overall, 63.9% had baseline thrombocytopenia, median (IQR) platelets of 38 (20, 63) ×103/μL. Baseline thrombocytopenia occurred in younger septic patients with higher illness severity. A ≥30% decline occurred in 33% of patients. Those with a ≥30% platelet decline were more commonly younger patients and had smaller catheters. Pre-CRRT thrombocytopenia and platelet decline were associated with ICU mortality in univariate but not multivariate models. There was no association with MAKE-90.</p><p><strong>Conclusions: </strong>Thrombocytopenia is common prior to CRRT initiation and is associated with greater illness severity. These findings stress the importance of vigilant monitoring of platelet levels before CRRT initiation and during therapy as thrombocytopenia at both time points may be a prognostic indicator. Additionally, this study highlights the need for future research to clarify the interplay of patient and mechanical factors in this phenomenon and guide potential interventions.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"322-333"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"184-194"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","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":"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":"102-110"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","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":"Bilirubin Removal with Therapeutic Plasma Exchange or Molecular Adsorbent Recirculating System as Treatment for Cholemic Nephropathy in Patients with Cirrhosis and Acute-on-Chronic Liver Failure: A Case Series.","authors":"Natalia Jiménez-Esquivel, Gastón Piñeiro, Adrià Carpio, Oswaldo Ortiz, Miquel Lozano, Leonardo Rodríguez-Carunchio, María Del Carmen Salgado, David Toapanta, Joan Cid, Octavi Bassegoda, Elena Cuadrado-Payán, Miquel Sanz, Paola Charry, Esteban Poch, Javier Fernández, Enric Reverter","doi":"10.1159/000543619","DOIUrl":"10.1159/000543619","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Cholemic nephropathy is an overlooked cause of acute kidney injury (AKI) in patients with cirrhosis and high bilirubin plasma levels (usually above 20 mg/dL), due to bilirubin and bile acid deposition in the kidneys. Those deposits have been hypothesized to cause tubular injury. It has no standardized diagnostic criteria or therapeutic strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We present a series of 15 patients with cirrhosis, acute-on-chronic liver failure (ACLF), and severe cholemic AKI, diagnosed by microscopic urinary cast visualization after excluding and treating other causes of AKI. Bilirubin plasma removal was performed with Molecular Adsorbent Recirculating System (MARS®, n = 3) or therapeutic plasma exchange (TPE, n = 12) to treat and prevent further kidney deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Kidney function improved in most of the patients; 5 patients also required transient hemodialysis, with only 1 patient evolving to end-stage chronic kidney disease needing liver-kidney transplant. Five patients underwent extended TPE sessions as a bridge to liver transplantation. Survival at 30 days and 1 year was 80% and 73%, respectively, with 10 patients undergoing transplantation along this year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this highly selected cohort of patients with cirrhosis, ACLF, and severe cholemic AKI, extracorporeal plasma removal techniques seem to improve kidney function and overall prognosis. Larger prospective and controlled studies are required to better understand this condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Cholemic nephropathy is an overlooked cause of acute kidney injury (AKI) in patients with cirrhosis and high bilirubin plasma levels (usually above 20 mg/dL), due to bilirubin and bile acid deposition in the kidneys. Those deposits have been hypothesized to cause tubular injury. It has no standardized diagnostic criteria or therapeutic strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;We present a series of 15 patients with cirrhosis, acute-on-chronic liver failure (ACLF), and severe cholemic AKI, diagnosed by microscopic urinary cast visualization after excluding and treating other causes of AKI. Bilirubin plasma removal was performed with Molecular Adsorbent Recirculating System (MARS®, n = 3) or therapeutic plasma exchange (TPE, n = 12) to treat and prevent further kidney deterioration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Kidney function improved in most of the patients; 5 patients also required transient hemodialysis, with only 1 patient evolving to end-stage chronic kidney disease needing liver-kidney transplant. Five patients underwent extended TPE sessions as a bridge to liver transplantation. Survival at 30 days and 1 year was 80% and 73%, respectively, with 10 patients undergoing transplantation along this year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this highly selected cohort of patients with cirrhosis, ACLF, and severe cholemic AKI, extracorporeal plasma removal t","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"160-166"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}