Blood Purification最新文献

{"title":"Treatment of Hemodialysis Vascular Access Repeated Stenosis with Paclitaxel-Coated Balloon Angioplasty: A Retrospective Study.","authors":"Chao Chen, Jun Gao, Feng Gong, Lihua Liu, Peng Shi, Shengyin Ma","doi":"10.1159/000535619","DOIUrl":"10.1159/000535619","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to report our experience of angioplasty with paclitaxel-coated balloon (PCB) versus common balloon (CB) for the treatment of repeated failing vascular access.</p><p><strong>Methods: </strong>Retrospective, single-center analysis consisting of 88 patients treated with percutaneous transluminal angioplasty in the period from October 2020 through December 2021. Patients were divided into two groups according to the type of treatment as PCB (n = 41) and CB (n = 47). We analyzed target lesion primary patency and vascular access primary patency for 6 months and the rate of complications.</p><p><strong>Results: </strong>There was no significant difference in the target lesion primary patency which was similar for 6 months between the two groups (PCB group vs. CB group at 1, 3, and 6 months; 95.12 vs. 89.36% (p = 0.55), 75.61 versus 74.47% (p = 0.90), 53.66% versus 63.83% (p = 0.33), respectively). Similarly, vascular access primary patency in the PCB group and CB group was 90.24 and 89.36% (p = 0.83), respectively, at 1 month, 65.85 and 68.09% (p = 0.82), respectively, at 3 months, 39.02 and 53.19% (p = 0.18), respectively, at 6 months. There were no major complications after endovascular treatment.</p><p><strong>Conclusion: </strong>Compared to CB angioplasty, PCB angioplasty has no short-term patency benefit in the treatment of vascular access repeated stenosis.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"486-492"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416289","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":"Erratum.","authors":"","doi":"10.1159/000535435","DOIUrl":"10.1159/000535435","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"325"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139575244","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":"Neonatal Extracorporeal Membrane Oxygenation: Associations between Continuous Renal Replacement Therapy, Thrombocytopenia, and Outcomes.","authors":"Lauren R Walker, Laura E Hollinger, W Michael Southgate, David T Selewski, Jeffrey E Korte, Mathew Gregoski, Heidi J Steflik","doi":"10.1159/000538010","DOIUrl":"10.1159/000538010","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of thrombocytopenia in neonates receiving extracorporeal membrane oxygenation (ECMO) with and without concurrent continuous renal replacement therapy (CRRT) and associated complications have not been well described. The primary aims of the current study were to (1) characterize thrombocytopenia in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with severe thrombocytopenia. In a planned exploratory secondary aim, we explored the association of severe thrombocytopenia with outcomes in neonates receiving ECMO.</p><p><strong>Methods: </strong>We conducted a retrospective single-center chart review of neonates who received ECMO 07/01/14-03/01/20 and evaluated associations between CRRT, severe thrombocytopenia (platelet count &lt;50,000/mm3), and outcomes (ECMO duration, length of stay, and survival).</p><p><strong>Results: </strong>Fifty-two neonates received ECMO; 35 (67%) received concurrent CRRT. Severe thrombocytopenia occurred in 27 (52%) neonates overall and in 21 (60%) neonates who received concurrent CRRT. Underlying diagnosis, ECMO mode, care unit, and moderate/severe hemolysis differed between those who did and did not receive CRRT. CRRT receivers experienced shorter hospital stays than CRRT non-receivers, but ECMO duration, length of intensive care unit (ICU) stay, and survival did not differ between groups. CRRT receipt was associated with severe thrombocytopenia. Exploratory classification and regression tree (CART) analysis suggests CRRT use, birthweight, and ICU location are all predictors of interest for severe thrombocytopenia.</p><p><strong>Conclusions: </strong>In our cohort, CRRT use during ECMO was associated with severe thrombocytopenia, and patients who received ECMO with CRRT experienced shorter hospital stays than those who did not receive CRRT. Exploratory CART analysis suggests CRRT use, birthweight, and ICU location are all predictors for severe thrombocytopenia and warrant further investigations in larger studies.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"665-675"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020882","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":"Effectiveness of Multidisciplinary Post-Acute Kidney Injury Clinic on Awareness and Knowledge in Acute Kidney Injury Survivors.","authors":"Peerapat Thanapongsatorn, Massupa Krisem, Kanyarat Kaewnan, Tidarat Bumrungpet, Nattachai Srisawat","doi":"10.1159/000535246","DOIUrl":"10.1159/000535246","url":null,"abstract":"<p><strong>Introduction: </strong>Acute kidney injury (AKI) awareness and knowledge among survivors is poor, leading to suboptimal self-management and follow-up care. The purpose of the study was to evaluate the impact of a multidisciplinary post-AKI clinic on AKI awareness and knowledge among survivors.</p><p><strong>Methods: </strong>We conducted a quasi-experimental study among stage 2-3 AKI survivors who were followed in the multidisciplinary post-AKI clinic, comprising nephrologists, renal nurses, pharmacists, and dietitians. Patients were evaluated before and after entering the clinic during a 3-month follow-up period, using a three-component questionnaire including the following: (1) Do you know of your AKI diagnosis during hospitalization? (yes/no), (2) how do you rate your AKI knowledge? (ranging from 1 or \"very low\" to 5 or \"excellent\"), and (3) 25-item objective AKI knowledge survey instrument that covered general knowledge of AKI, nutrition, medication, and symptoms of renal failure.</p><p><strong>Results: </strong>A total of 108 AKI survivors were enrolled, with 37.0%, 41.7%, and 21.3% being stage 2 AKI, stage 3 AKI, and stage 3-dialysis AKI, respectively. Before entering the clinic, 50% of patients were unaware of their AKI during hospitalization. After receiving education from the multidisciplinary post-AKI clinic, all patients became aware they had experienced AKI. The mean perceived knowledge and objective knowledge scores were significantly increased over the 3-month period from 1.6 (0.7) to 3.9 (0.7) out of 5 and 15.4 (3.5) to 21.4 (2.0) out of 25, respectively (p &lt; 0.001 for both). Additionally, reverse transformation of the Likert scale to a percentage format also revealed a significant improvement in mean perceived AKI knowledge scores, transitioning from 13.8 ± 16.8 to 73.0 ± 17.6, p &lt; 0.001.</p><p><strong>Conclusion: </strong>The multidisciplinary post-AKI clinic effectively enhanced AKI awareness and knowledge among survivors. These findings highlight the importance of follow-up care and the benefits of a multidisciplinary approach. Further studies are needed to determine the long-term outcomes associated with increased knowledge.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"268-278"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138290222","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":"Factors Associated with Dialysis Initiation in Patients with Predialysis Arteriovenous Fistula.","authors":"Wanhong Lu, Xiangyun Dang, Chao Liu, Zhigang Wang, Jing Lv, Shifeng Yang, Huixian Li","doi":"10.1159/000535251","DOIUrl":"10.1159/000535251","url":null,"abstract":"<p><strong>Introduction: </strong>A large proportion of patients initiated hemodialysis with a central vein catheter rather than a permanent vascular access which was recommended by guidelines. One major barrier was the paucity of evidence regarding the optimal timing of vascular access creation in predialysis patients.</p><p><strong>Methods: </strong>Our study prospectively enrolled 300 patients undergoing predialysis arteriovenous fistula (AVF) creation in our center from 2015 to 2018. Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of hemodialysis after AVF surgery. A receiver operating characteristic area under the curve (AUC) was used to assess the predictive power of preoperative factors for the likelihood of hemodialysis initiation.</p><p><strong>Results: </strong>Overall, 163 (54.3%), 214 (71.3%), and 275 (91.7%) patients initiated hemodialysis within 3 months, 6 months, and 1 year, respectively, after AVF creation. The median time between AVF creation and hemodialysis start was 71.5 days. Using multivariate Cox regression analysis, three factors were associated with hemodialysis initiation within 1 year: serum phosphorus (HR = 1.407, p = 0.021), diabetic kidney disease (DKD) (HR = 1.429, p = 0.039), and cystatin C (HR = 1.179, p = 0.009). Cystatin C alone had a moderate predictive value for dialysis initiation (AUC = 0.746; p &lt; 0.001), whereas the full model had a higher predictive value (AUC = 0.800; p &lt; 0.001).</p><p><strong>Conclusion: </strong>DKD, serum cystatin C, and phosphorus at access surgery were associated with hemodialysis initiation within 1 year of the predialysis AVF creation. Our findings provide a basis for a more customized approach to planning AVF placement in patients with chronic kidney disease.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"210-218"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648421","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 42nd Vicenza Course AKI-CRRT-ECOS and Critical Care Nephrology.","authors":"","doi":"10.1159/000540416","DOIUrl":"10.1159/000540416","url":null,"abstract":"<p><p>Selected abstracts from the 42nd Vicenza Course AKI-CRRT-ECOS and Critical Care Nephrology.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":"53 Suppl 1","pages":"1-89"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944044","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":"Hepcidin Removal during Continuous Renal Replacement Therapy.","authors":"James F Colbert, Benjamin R Griffin, Kristy Rolloff, Christopher L Erzen, Sarah M Haeger, Chris Altmann, Kayo Okamura, Ruth Campbell, Isaac Teitelbaum, Sarah Faubel","doi":"10.1159/000534297","DOIUrl":"10.1159/000534297","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute kidney injury (AKI) or end stage kidney disease (ESKD) may require continuous renal replacement therapy (CRRT) as a supportive intervention. While CRRT is effective at achieving solute control and fluid balance, the indiscriminate nature of this procedure raises the possibility that beneficial substances may similarly be removed. Hepcidin, an antimicrobial peptide with pivotal roles in iron homeostasis and pathogen clearance, has biochemical properties amenable to direct removal via CRRT. We hypothesized that serum hepcidin levels would significantly decrease after initiation of CRRT.</p><p><strong>Methods: </strong>In this prospective, observational trial, we enrolled 13 patients who required CRRT: 11 due to stage 3 AKI, and 2 due to critical illness in the setting of ESKD. Plasma was collected at the time of enrollment, and then plasma and effluent were collected at 10:00 a.m. on the following 3 days. Plasma samples were also collected from healthy controls, and we compared hepcidin concentrations in those with renal disease compared to normal controls, evaluated trends in hepcidin levels over time, and calculated the hepcidin sieving coefficient.</p><p><strong>Results: </strong>Plasma hepcidin levels were significantly higher in patients initiating CRRT than in normal controls (158 ± 60 vs. 17 ± 3 ng/mL respectively, p &lt; 0.001). Hepcidin levels were highest prior to CRRT initiation (158 ± 60 ng/mL), and were significantly lower on day 1 (102 ± 24 ng/mL, p &lt; 0.001) and day 2 (56 ± 14 ng/mL, p &lt; 0.001) before leveling out on day 3 (51 ± 11 ng/mL). The median sieving coefficient was consistent at 0.82-0.83 for each of 3 days.</p><p><strong>Conclusions: </strong>CRRT initiation is associated with significant decreases in plasma hepcidin levels over the first 2 days of treatment regardless of indication for CRRT, or presence of underlying ESKD. Since reduced hepcidin levels are associated with increased mortality and our data implicate CRRT in hepcidin removal, larger clinical studies evaluating relevant clinical outcomes based on hepcidin trends in this population should be pursued.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"23-29"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477601","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":"Predictions of Serum Phosphate Concentration during Continuous Renal Replacement Therapy Using a Steady-State Mass Balance Model.","authors":"John K Leypoldt, Jorge Echeverri, Kai Harenski, Kuljinder Singh","doi":"10.1159/000533322","DOIUrl":"10.1159/000533322","url":null,"abstract":"<p><strong>Introduction: </strong>Hypophosphatemia is common during continuous renal replacement therapy (CRRT), but serum phosphate levels can potentially be maintained during treatment by either intravenous phosphate supplementation or addition of phosphate to renal replacement therapy (RRT) solutions.</p><p><strong>Methods: </strong>We developed a steady-state phosphate mass balance model to assess the effects of CRRT dose on serum phosphate concentration when using both phosphate-free and phosphate-containing RRT solutions, with emphasis on low CRRT doses.</p><p><strong>Results: </strong>The model predicted that measurements of serum phosphate concentration prior to (initial) and during CRRT (final) together with clinical data on CRRT dose, treatment duration, and phosphate supplementation can determine model patient parameters, that is, both the initial generation rate and clearance of phosphate prior to CRRT. Model parameters were then calculated from average patient data reported in several previous publications with a standard or high CRRT dose. Using representative model parameters for typical patients, predictions were then made of the effect of low CRRT dose on the change in serum phosphate levels after implementation of CRRT. The model predicted that CRRT at a low dose using phosphate-free RRT solutions will limit, but not eliminate, the incidence of hypophosphatemia. Further, the model predicted that CRRT at a low dose will have virtually no influence on the incidence of hyperphosphatemia when using phosphate-containing RRT solutions.</p><p><strong>Conclusions: </strong>This report identifies the clinical measurements to be used with the proposed model for individualizing the CRRT dose and RRT phosphate concentration to maintain serum phosphate concentrations in a desired range.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"40-48"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71477638","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":"Fluid Balance in Continuous Renal Replacement Therapy: Prescribing, Delivering, and Review.","authors":"Ian Charles Baldwin, Amy McKaige","doi":"10.1159/000537928","DOIUrl":"10.1159/000537928","url":null,"abstract":"<p><strong>Background: </strong>Historically IV and enteral fluids given during acute kidney injury (AKI) were restricted before the introduction of continuous renal replacement therapies (CRRTs) when more liberal fluids improved nutrition for the critically ill. However, fluid accumulation can occur when higher volumes each day are not considered in the fluid balance prescribing and the NET ultrafiltration (NUF) volume target.</p><p><strong>Key messages: </strong>The delivered hours of CRRT each day are vital for achievement of fluid balance and time off therapy makes the task more challenging. Clinicians inexperienced with CRRT make this aspect of AKI management a focus of rounding with senior oversight, clear communication, and \"precision\" a clinical target. Sepsis-associated AKI can be a complex patient where resuscitation and admission days are with a positive fluid load and replacement mind set. Subsequent days in ICU requires fluid regulation, removal, with a comprehensive multilayered assessment before prescribing the daily fluid balance target and the required hourly NET plasma water removal rate (NUF rate). Future machines may include advanced software, new alarms - display metrics, messages and association with machine learning and \"AKI models\" for setting, monitoring, and guaranteeing fluid removal. This could also link to current hardware such as on-line blood volume assessment with continuous haematocrit measurement.</p><p><strong>Summary: </strong>Fluid balance in the acutely ill is a challenge where forecasting and prediction are necessary. NUF rate and volume each hour should be tracked and adjusted to achieve the daily target. This requires human and machine connections.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"533-540"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911937","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":"It Is All in the Name: Standard Nomenclature for Extracorporeal Purification.","authors":"Mitchell H Rosner, Claudio Ronco","doi":"10.1159/000537909","DOIUrl":"10.1159/000537909","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"327-328"},"PeriodicalIF":3.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982272","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}