Blood Purification最新文献

{"title":"Reducing Methane Emissions from Spent Dialysate through Circular Solutions.","authors":"Faissal Tarrass, Meryem Benjelloun","doi":"10.1159/000550652","DOIUrl":"10.1159/000550652","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"234-236"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146028175","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 \"Sword of Damocles\" in Therapeutic Apheresis: Revisiting the Rebound and Overshoot Phenomena.","authors":"Yandy Marx Castillo-Aleman","doi":"10.1159/000550384","DOIUrl":"10.1159/000550384","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"231-233"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Daprodustat on Iron Metabolism in Peritoneal Dialysis Patients: An Exploratory Study.","authors":"Tomohiro Yan, Yukinao Sakai, Shunnosuke Kunoki, Akio Hirama, Tetsuya Kashiwagi, Masato Iwabu","doi":"10.1159/000548832","DOIUrl":"10.1159/000548832","url":null,"abstract":"<p><strong>Introduction: </strong>Renal anemia is a serious complication in patients with chronic kidney disease. Daprodustat, a hypoxia-inducible factor-prolyl hydroxylase inhibitor, represents a potential therapeutic option for renal anemia; however, its efficacy and safety in patients maintained on peritoneal dialysis (PD) remain unknown. This exploratory study aimed to evaluate the preliminary effects of daprodustat in patients with chronic kidney disease undergoing maintenance PD.</p><p><strong>Methods: </strong>This single-center, prospective study included 11 patients undergoing maintenance PD who shifted from darbepoetin alfa to daprodustat. Over a 24-week observation period, hematological parameters, iron metabolism markers, cardiac function, and oxidative stress indicators were monitored. Statistical significance was determined using repeated-measures ANOVA with Bonferroni correction for multiple comparisons.</p><p><strong>Results: </strong>Hepcidin-25 levels (p = 0.0004) and oxidized low-density lipoprotein levels (p = 0.0437) significantly decreased, while total iron-binding capacity (p = 0.0043) and reticulocyte counts (p = 0.0052) significantly increased. Despite these favorable biochemical changes, hemoglobin and hematocrit values showed no significant improvement. Other oxidative stress markers showed downward trends, while cardiac function parameters (N-terminal pro-brain natriuretic peptide, cardiothoracic ratio, left ventricular ejection fraction) remained unchanged.</p><p><strong>Conclusion: </strong>This pilot study suggests that daprodustat may enhance iron metabolism and mitigate oxidative stress while preserving cardiac function in PD patients. The pronounced reduction in hepcidin-25 levels indicates potential beneficial effects on iron homeostasis. However, the absence of significant hemoglobin improvement, combined with the small sample size (n = 11), lack of control group, and short 24-week follow-up period, significantly limits the clinical relevance and generalizability of these findings. Larger randomized controlled trials with longer follow-up periods are essential to definitively establish the efficacy and safety of daprodustat in this patient population.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"35-43"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145228395","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 Effect of Far Infrared Treatment on Changes in Biomarkers in the Arteriovenous Fistula.","authors":"Emilie K Hansen, Ditte Hansen, Casper Schalkwijk, Marjo Waarenburg, Henrik Post Hansen, Kristine Lindhard","doi":"10.1159/000547478","DOIUrl":"10.1159/000547478","url":null,"abstract":"<p><strong>Introduction: </strong>Far infrared radiation may improve arteriovenous fistula maturation and patency rates in patients on hemodialysis (HD). The mechanism is proposed to involve anti-inflammatory and vasodilatory effects in the arteriovenous fistula. This study examined the impact of far infrared radiation on plasma changes and dialysate excretion of biomarkers of endothelial dysfunction, inflammation, and vasodilation in the arteriovenous fistula during a single HD.</p><p><strong>Methods: </strong>The study was a randomized, controlled, single-blinded study involving 44 participants on HD with an arteriovenous fistula. Participants were randomized to far infrared radiation or no far infrared radiation (control). Blood samples and dialysate water were drawn before, during, and after 4 h of HD. The change and elimination of biomarkers of endothelial dysfunction, inflammation, and vasodilation was explored in blood and dialysate water, respectively. Changes in plasma levels from the start to the end of HD and the area under the curve for the biomarker concentration were compared between groups by ANCOVA.</p><p><strong>Results: </strong>There was no difference in the change of biomarkers of endothelial dysfunction, inflammation, and vasodilation between the two groups after and during 4 h of HD. There was a minimal excretion of the biomarkers in the dialysate water. Regardless of the treatment group, 4 h of HD caused a significant decrease in tumor necrosis factor-alpha (-1.30 [-1.70; -1.03] pg/mL, p < 0.001), monocyte chemoattractant protein-1 (-32.50 [-50.50; -8.25] pg/mL, p < 0.001), nitrite and nitrate (-20.00 [-27.75; -14.00] µmol/L, p < 0.001) as well as asymmetric dimethylarginine (-0.24 [-0.28; -0.18] µmol/L, p < 0.001).</p><p><strong>Conclusion: </strong>Overall, the study is not supportive of a beneficial effect of far infrared radiation on the arteriovenous fistula on biomarkers of endothelial dysfunction, inflammation, or vasodilation during one HD treatment.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"44-53"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051816","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":"Interactions between Poisons, Patients, and Extracorporeal Blood Purification Therapies: A Comprehensive Analysis.","authors":"Matteo Pernazza, Gianluca Castellani, Matteo Marrocu, Elena Costantini, Giuseppe Gigliotti, Gianluca Villa","doi":"10.1159/000549094","DOIUrl":"10.1159/000549094","url":null,"abstract":"<p><strong>Background: </strong>Poisonings can harm through their direct effect or determining organ dysfunction. Extracorporeal blood purification therapies (EBPT) have been used for decades in case of poisonings. Although poisoning remains a major public health issue, focusing on organ dysfunction rather than the poison itself has significantly reduced mortality rates.</p><p><strong>Summary: </strong>This review explores the complex and dynamic interactions among poisons, patients, and EBPT and describes specific poisonings where EBPT may be indicated.</p><p><strong>Key messages: </strong>EBPT are indicated in many cases of intoxication, either to enhance clearance or for organ support. A thorough understanding of the interactions between poisons, patients, and EBPT is mandatory for proper management of each specific intoxication.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"91-106"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342967","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":"An Indian Consensus on the Use of Online Hemodiafiltration in Patients with Chronic Kidney Disease.","authors":"Sourabh Sharma, Urmila Anandh, Sant Kumar Pandey, Salil Jain, Girish Vasudeorao Kumthekar, Mohit Khirbat, Raka Kaushal, Yogesh Kumar Gaur, Shailesh Kakde, Manju Thampi, Manisha Sahay","doi":"10.1159/000551491","DOIUrl":"10.1159/000551491","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in dialysis technology have improved the management of end-stage kidney disease; however, survival rates and quality of life on conventional hemodialysis (HD) remain suboptimal. Hemodiafiltration (HDF) offers superior clearance of middle molecules, improved hemodynamic stability, and reduced mortality than conventional HD. Despite these advantages, HDF adoption in India remains inconsistent due to lack of national guidelines, cost concerns, and limited awareness of long-term benefits.</p><p><strong>Methods: </strong>A modified Delphi methodology was utilized to develop consensus-based recommendations on the use of HDF in India. A panel of 11 experienced nephrologists from diverse clinical settings participated in multiple rounds of discussions. Consensus statements were formulated across six domains: patient selection, dialysis adequacy, vascular access, therapy goals and outcome, HDF utilization techniques, and patient involvement in HDF therapy. Consensus required >90% agreement (\"agree\" or \"strongly agree\") on a 5-point Likert scale. A total of 50 draft consensus statements on HDF were developed and subjected to anonymous voting by the expert panel.</p><p><strong>Result: </strong>In the first voting round, 46 statements met the predefined consensus threshold. Four statements that did not reach consensus were revised following discussion in a second virtual meeting. Ultimately, 48 of 50 statements achieved consensus, while 2 were discarded due to lack of agreement. Strong consensus was observed regarding the role of HDF in improving survival, cardiovascular outcomes, hemodynamic stability, and quality of life. Recommendations were also established for patient selection, adequacy monitoring, vascular access, technical aspects of HDF delivery, water quality standards, and strategies to enhance patient engagement and wider adoption of HDF in India.</p><p><strong>Conclusion: </strong>This consensus demonstrated strong agreement among Indian nephrologists on key aspects of HDF, including patient selection, therapy goals, and technical considerations. These recommendations aim to standardize HDF practice and promote its wider adoption in India, ultimately improving care quality and outcomes for patients with chronic kidney disease requiring kidney replacement therapy.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"626-641"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13694056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147761234","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":"Hemodialysis for Severe Metabolic Alkalosis: A Comprehensive Review of Current Practices.","authors":"Eduardo Rodolfo Ávila, Rodrigo Andrés Sepúlveda","doi":"10.1159/000547475","DOIUrl":"10.1159/000547475","url":null,"abstract":"<p><strong>Background: </strong>Metabolic alkalosis is very common in hospitalized patients, and it is due to a negative H+ balance with base gain, especially <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>. When metabolic alkalosis is severe (pH ≥7.55) or extreme (pH >7.6), it is associated with extremely high morbidity and mortality, since, in addition to the underlying pathology, alkalemia itself generates serious organic repercussions and must be corrected promptly. Specifically, severe metabolic alkalosis is associated with increased adrenergic sensitivity, ionic hypocalcemia, hypokalemia, neuromuscular complications, myocardial and cerebral ischemia.</p><p><strong>Summary: </strong>This narrative review explores literature reports where renal replacement therapy has been used to control severe metabolic alkalosis. It also analyzes side effects and response to therapy and attempts to provide recommendations regarding how to manage severe metabolic alkalosis with hemodialysis (HD).</p><p><strong>Key messages: </strong>In severe and extreme metabolic alkalosis, in addition to diagnosing and treating the underlying cause, it is necessary to promptly remove excess bases, which can be achieved through renal replacement therapy. Intermittent HD with low bicarbonate in the dialysate has proven to be very effective for its management.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"65-78"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279016","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 Reduced Dialysate Flow on Dialysis Adequacy: A Pilot Study.","authors":"Mohamed Belmouaz, Charles Dibon, Jean-Philippe Devaux, Fabien Duthe, Romain Wong-Cheng, Clemence Lemarchand, Laure Ecotiere, Jean-Marc Gombert, Florence Jacomet, Sarah Ayraud-Thevenot, Lisa Durocher, Antoine Thierry, Pierre-Jean Saulnier, Frank Bridoux","doi":"10.1159/000549110","DOIUrl":"10.1159/000549110","url":null,"abstract":"<p><strong>Introduction: </strong>The standard dialysate flow (Qd) for hemodialysis (HD) is currently set at 500 mL/min. One potential, sustainable, and cost-effective solution for eco-friendly HD may involve reducing Qd to limit wastewater. However, the effect of reduced Qd on small molecule and middle molecule (MM) removal remains to be investigated.</p><p><strong>Methods: </strong>In this prospective observational study, 74 patients on different maintenance dialysis modalities with Qd set at 500 mL/min (Qd500) were assigned to receive Qd at 400 mL/min (Qd400) for 3 months. Dialysis adequacy, including small solute removal and MM reduction ratio (RR), was evaluated at enrollment and after 3 months.</p><p><strong>Results: </strong>Compared to Qd500, Qd400 after 3 months achieved similar single-pool Kt/V (1.41 ± 0.30 vs. 1.43 ± 0.33, p = 0.58), equilibrated KT/V, urea RR, creatinine RR, and phosphate RR. Qd400 vs. Qd500 provided significantly higher beta2-microglobulin RR (77.0 [71.4-81.7] vs. 74.7 [68.4-79.4] %, p = 0.009) and lower kappa free light chain (FLC) RR (54.2 [42.1-64.4] vs. 57.6 [41.6-65.0] %, p = 0.03), whereas myoglobin and lambda FLC RR were similar. Qd400 resulted in higher pre-dialysis urea (20.2 ± 5.5 vs. 18.2 ± 6.2 mmol/L, p = 0.002), creatinine (694.0 ± 179.5 vs. 665.6 ± 220.4 µmol/L, p = 0.029), beta2-microglobulin (26.5 [23.0-30.0] vs. 23.5 [20.0-28.0] mg/L, p = 0.0001), and myoglobin (174.0 [122.0-251.0] vs. 159.5 [119.0-195.0] µg/L, p = 0.033) levels. Pre-dialysis levels of albumin, potassium, bicarbonate, phosphate, and calcium were similar between Qd400 and Qd500.</p><p><strong>Conclusion: </strong>Three months of Qd at 400 mL/min appears to provide similar small molecule and MM removal, but with an increase in pre-dialysis urea, creatinine, beta2-microglobulin, and myoglobin levels. Although this strategy could help preserve water, its potential impact on long-term clinical outcomes deserves further evaluation.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"138-147"},"PeriodicalIF":1.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145342945","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":"Expanded Hemodialysis as an Alternative to Suboptimal Online Hemodiafiltration.","authors":"Martín Giorgi, Ana Sánchez-Horrillo, María Riutort-Garvi, Jesús Bonilla-Rico, Melissa Liriano-Alba, Daniela Abzueta, Ignacio Gómez-Rojas, Aranzazu Alfranca, Eva Sanjuán-Suria, Marta Fernández-Sampedro, Natalia F Pascual Gómez, María A Bajo, Borja Quiroga","doi":"10.1159/000550038","DOIUrl":"10.1159/000550038","url":null,"abstract":"<p><strong>Introduction: </strong>Online hemodiafiltration (OLHDF) is associated to reduction in cardiovascular events and mortality when achieving high-dose convective volume. However, not all patients are able to reach the optimal volume of OLHDF or are not eligible for OLHDF. The aim of the present study was to compare expanded hemodialysis (HDx) and suboptimal post-dilution OLHDF in the reduction of solutes.</p><p><strong>Methods: </strong>In this observational prospective study, we included all the patients of our hemodialysis units with suboptimal (i.e., convective volume <19.2 L) OLHDF. After a minimum of 1 month in OLHDF, patients were switched to HDx for another month. Removal ratio (RR) for small, medium, and large molecules was calculated for each period. In addition, we compared the global removal score (GRS) with both techniques.</p><p><strong>Results: </strong>Twelve patients were included (58% male, 68 ± 16 years) and completed the study. OLHDF displayed higher RR of urea (p = 0.011), prolactin (p < 0.001), β2-microbloglulin (p = 0.011), myoglobin (p = 0.015), kappa free light chains (FLCs) (p = 0.04), and lambda FLC (p = 0.012). In contrast, OLHDF and HDx presented similar RR of creatinine, C-reactive protein, albumin, α2-macroglobulin, interleukin (IL)-1, IL-6, IL-8, IL-10, IL12, TNF-α, metalloproteinase-1, and p-cresol. The GRS was similar in OLHDF and HDx (55 [46-70]% vs. 51 [41-59]%, NS).</p><p><strong>Conclusion: </strong>HDx presents a similar GRS in comparison to OLHDF demonstrating that this technique can be prescribed in cases of suboptimal convective volume achievement.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"189-196"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002907","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":"Basic Mechanisms of Hemoadsorption: Incumbency for Better Clinical Utility.","authors":"Thiago Reis, Vedran Premužić, Koody Kitawara, Irene L Noronha, Claudio Ronco","doi":"10.1159/000548120","DOIUrl":"10.1159/000548120","url":null,"abstract":"<p><strong>Background: </strong>The term adsorption is defined as the process in which molecules accumulate in the interfacial surface layer of a solid. The solid material is the sorbent, and the substance in the adsorbed state is called adsorbate. The basic principles and mechanisms involved in hemoadsorption include flow dynamics, chemical characteristics of synthetic materials, adsorption isotherms, mass transfer zone, and the Vroman effect. The development of devices and materials for hemoadsorption started in the 1970s, where activated charcoal coated in a plastic case was used as a sorbent for patients with drug overdose. Further developments of adsorbent materials led to the creation of several cartridges, which are now available for clinical use and are deployed for a myriad of purposes. Indications for hemoadsorption include sepsis, intoxication, drug overdose, acute kidney injury, rhabdomyolysis, cytokine release syndromes, acute liver failure, antibody-mediated autoimmune diseases, and uremia.</p><p><strong>Summary: </strong>Herein, we aimed to describe the mechanisms involved in the adsorptive process and explore the singular properties of the commercially available devices for hemoadsorption.</p><p><strong>Key messages: </strong>The devices deployed to adsorption are cartridges or filters. In cartridges, blood or plasma interacts with polymers in the form of beads, powder, flakes, granules, or a mesh of fibers. In filters, blood is exposed to a synthetic membrane in the form of hollow fibers. In research, clinical practice, and education, it is essential to specify the device and the adsorbent material used for hemoadsorption, since their properties and targets may vary entirely. Nephrologists and intensivists should be familiarized with the mechanisms and principles of hemoadsorption as these treatments are now being routinely applied.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"340-353"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144941550","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}