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Blood Purification

Enrico Vidal, Enrico Cocchi, Fabio Paglialonga, Zaccaria Ricci, Francesco Garzotto, Licia Peruzzi, Luisa Murer, Claudio Ronco
We report the first worldwide experience with continuous veno-venous hemodialysis (CVVHD) in children using the last generation Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM)TM device. Thirteen children received 1,008 h of CVVHD during 95 sessions, using a 0.15 (n = 7) or a 0.25 m2 (n = 6) hemofilter. The median weight was 3 kg (interquartile range [IQR] 2.5-6.2). In 10 patients, CVVHD was conducted using a 5 Fr double-lumen central vascular access, whereas in 3 children, bigger sizes were used (6...
October 31, 2018: Blood Purification
Gerardo Guillermo-Corpus, Jesus Manolo Ramos-Gordillo, José Carlos Peña-Rodríguez
BACKGROUND: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. MATERIAL AND METHODS: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. RESULTS: The survival of the tunneled catheters was 771 days 95% CI (737-805) for jugular and 660 days 95% CI (582-739) for femoral veins...
October 25, 2018: Blood Purification
Yu Zhang, Liang Li, Xiaole Zhang, Wen Xu, Qun Guo, Jianhua Zhou
Wilsonian crisis (hemolytic crisis and acute liver failure [ALF] in Wilson's disease) is fatal and almost all patients ultimately need a timely liver transplantation to save their lives. How to safely pass the critical period to liver transplantation is still a big challenge to doctors especially to pediatricians facing more difficult situations in blood purification. Here, we report about a 7-year-old child (weight 21 kg) presenting with severe hemolysis and impending ALF that made a rapid recovery with prompt initiation of plasmapheresis combined with continuous plasma filtration adsorption (CPFA) and chelation therapy...
October 25, 2018: Blood Purification
Anna Clementi, Grazia Maria Virzì, María-Jimena Muciño-Bermejo, Federico Nalesso, Davide Giavarina, Mariarosa Carta, Alessandra Brocca, Massimo de Cal, Tommaso Hinna Danesi, Monica Zanella, Nicola Marchionna, Alessandra Brendolan, Giovanni Giorgio Battaglia, Loris Salvador, Claudio Ronco
Backgound: This study was aimed at evaluating the presepsin and procalcitonin levels to predict adverse postoperative complications and mortality in cardiac surgery patients. METHODS: A total of 122 cardiac surgery patients were enrolled for the study. Presepsin and procalcitonin levels were measured 48 h after the procedure. The primary endpoints were adverse renal, respiratory, and cardiovascular outcomes and mortality. RESULTS: Presepsin and procalcitonin levels were significantly higher in patients with adverse renal and respiratory outcome (p < 0...
October 18, 2018: Blood Purification
Javier Reque, Alejandro Pérez Alba, Nayara Panizo, Juan José Sánchez-Canel, Maria Jose Pascual, Ramón Pons Prades
BACKGROUND: Recent evidence suggests a better reduction rate of some uremic toxins with expanded hemodialysis (HDx). METHODS: Prospective study including 8 hemodialysis patients. We divided the study in 2 phases; within the first one, we assigned 4 patients (group 1) to undergo online hemodiafiltration with a PF 210H dialyzer, and the other 4 patients (group 2) to undergo HDx with the high retention onset Theranova 500 dialyzer during 24 sessions. Later, during the second phase and after a washout period, the same patients were switched to receive HDx (group 1) and HDF (group 2)...
October 12, 2018: Blood Purification
Jean-Louis Vincent
No abstract text is available yet for this article.
October 10, 2018: Blood Purification
John K Leypoldt, Edward F Vonesh
BACKGROUND/AIMS: We derived a novel equation for calculating weekly urea standard Kt/V (stdKt/V) during hemodialysis (HD) based on urea mass removed, comparable to the approach during peritoneal dialysis. METHODS: Theoretical consideration of urea mass balance during HD led to the following equation for stdKt/V, namely, stdKt/V = N × (URR + UFV/V), where N is the number of treatments per week, URR is urea reduction ratio per treatment, UFV is ultrafiltration volume per treatment, and V is postdialysis urea distribution volume...
October 8, 2018: Blood Purification
Silvio Borrelli, Roberto Minutolo, Emanuele De Simone, Walter De Simone, MIchele Provenzano, Luca De Nicola, Giuseppe Conte, Carlo Garofalo
Mid-dilution hemodiafiltration (MID) is a dialytic technique that might improve systemic inflammation of patients in chronic hemodialysis (HD) by increasing substitution volumes. To verify this hypothesis, we performed a prospective cross-over study comparing the effect on inflammatory biomarkers of higher convection by MID versus standard convection by post-dilution hemodiafiltration (HDF). Patients under chronic HD were therefore treated by MID and HDF by crossover design. Each treatment period lasted 4 months, with 1 month of wash-out where patients were treated by HD, for a total of 9 months...
October 5, 2018: Blood Purification
Kumar Digvijay, Mauro Neri, Weixuan Fan, Zaccaria Ricci, Claudio Ronco
INTRODUCTION: Definition, prevention, and management of acute kidney injury (AKI) and the optimal prescription and delivery of renal replacement therapy (RRT) are currently matters of ongoing discussion. Due to the lack of definitive published literature, a wide gap might exist between routine clinical practice and available recommendations. The aim of this survey was to explore the clinical approach to AKI and RRT in a broad population of nephrologists and intensivists participating in the 36th International course on AKI and Continuous RRT (CRRT), held in Vicenza in June 2018...
September 28, 2018: Blood Purification
Renhua Lu, Chenqi Xu, Yan Li, Ling Yu, Xinghua Shao, Kewei Xie, Jiaqi Gu, Zanzhe Yu, Yucheng Yan, Yangtai Guan, Zhaohui Ni, Claudio Ronco, Leyi Gu
OBJECTIVE: To investigate the incidence and the prognosis of cognitive impairment (CI) and to find out the risk factors associated with the outcome in maintenance haemodialysis (MHD) patients. METHODS: Enrolled the patients who met the criteria as below: MHD (≥3 months) patients before July 2014, ≥18 years old and could carry on the cognitive function test (Montreal Cognitive Assessment [MoCA]). All enrolled patients were divided into 2 groups: CI group (MoCA < 26) and non-CI group (MoCA ≥26)...
September 25, 2018: Blood Purification
Ghada Ankawi, Weixuan Fan, Diego Pomarè Montin, Anna Lorenzin, Mauro Neri, Carlotta Caprara, Massimo de Cal, Claudio Ronco
Adsorption is an extracorporeal technique utilized for blood purification. It complements convection and diffusion (the main modalities of solute removal). It involves the passage of blood (or plasma) through an adsorption cartridge, where solutes are removed by direct binding to the sorbent material. Over the years, new adsorption cartridges, with improved characteristics have been developed. Furthermore, the therapeutic applications of adsorption have expanded. These now involve the treatment of inflammatory conditions, chronic uremic symptoms, and autoimmune disease, in addition to intoxication, which was once considered the classical indication for adsorption therapy...
September 25, 2018: Blood Purification
Michele Claudio Vassallo, Fabiana Tartamella, Pradipta Bhakta
No abstract text is available yet for this article.
September 25, 2018: Blood Purification
Pan Xie, Min Tao, Kanfu Peng, Hongwen Zhao, Keqin Zhang, Yuxiu Sheng, Ghada Ankawi, Claudio Ronco
Kidney transplantation (KT) is considered an optimal treatment strategy for end-stage renal disease. But human leukocyte antigen-sensitized, ABO-incompatible and antibody-mediated rejection might be the alarming hurdles in KT. Therapeutic plasma exchange is the mainstay of the antibody reduction therapy for reducing autoantibody more effectively. Even in the treatment for highly sensitized patients, it has played an indispensable role. However, clinicians should tailor therapies to individual patient's needs and multimodal treatment will bring better outcomes...
September 25, 2018: Blood Purification
Richard Paul Lion, Naile Tufan Pekkucuksen, Poyyapakkam Srivaths, Moreshwar S Desai, Ayse Akcan Arikan
AIMS: To establish the safety and efficacy of regional citrate anticoagulation (RCA) for pediatric liver failure (LF) patients receiving extracorporeal liver support (ELS) with albumin-assisted dialysis. METHODS: Retrospective review of pediatric LF patients receiving ELS from April 2014 to December 2016 at a tertiary children's hospital pediatric intensive care unit. Demographic and ELS data collected by chart review. Citrate accumulation (CA) was defined as total calcium (mmol/L): ionized calcium (mmol/L) > 2...
September 25, 2018: Blood Purification
Sigrid Kalle, Risto Tanner, Merike Luman, Ivo Fridolin
The aim of this study was to primarily explore the relationship between free pentosidine and the fluorescence properties of spent dialysate, and also to develop a model to assess the levels of free pentosidine in spent dialysate based on the fluorescence measurements. First, 40 patients (20 females and 20 males) were examined during 40 dialysis sessions. High-pressure liquid chromatography (HPLC) was used to measure the free pentosidine concentrations from the spent dialysate. The full fluorescence spectra of the spent dialysates were recorded and single- and multi-wavelength (MW) models were developed...
September 25, 2018: Blood Purification
Giorgio Berlot, Stefano Falini, Virginia Negro, Antoinette Agbedjro, Ariella Tomasini, Fulvio Iscra, Francesco Bianco, Ugo Gerini, Giuliano Boscutti
No abstract text is available yet for this article.
September 24, 2018: Blood Purification
Maurizio Bossola, Enrico Di Stasio, Tania Monteburini, Emanuele Parodi, Fabio Ippoliti, Stefano Cenerelli, Stefano Santarelli, Pier Eugenio Nebiolo, Vittorio Sirolli, Mario Bonomini, Manuela Antocicco, Giuseppe Zuccalà, Alice Laudisio
INTRODUCTION: The present study aimed to determine the variables that are associated with a longer dialysis recovery time (DRT) and to define the relationship that exists between DRT and the ultrafiltration rate (UFR) in prevalent chronic hemodialysis (CHD) patients. METHODS: We studied 210 prevalent CHD of 5 hemodialysis units in Central Italy. Patients were invited to answer to the question: "How long does it take you to recover from a dialysis session?" Answers to this question were subsequently converted into minutes...
September 19, 2018: Blood Purification
Mayanka Kamboj, Amir Kazory
Over the last decades, there have been major advancements in the field of renal replacement therapy (RRT) with utilization of newer technologies and advent of various modalities. Once exclusively used for treatment of renal failure and its metabolic consequences, the science of RRT has expanded to include non-renal indications such as treatment of fluid overload in patients with refractory heart failure. Hepatic encephalopathy due to sudden rise in serum ammonia level in the setting of acute liver failure represents an underexplored area in which RRT can potentially be helpful...
September 18, 2018: Blood Purification
Pan Xie, Kanfu Peng, Keqin Zhang, Hongwen Zhao, Yuxiu Sheng, Min Tao, Qian Yuan, Claudio Ronco
In most situations, central catheters are implanted in the right jugular vein as initial access for hemodialysis. However, after repeated punctures, the proximal vessels become stenosed and thrombosed and misplacement is likely to occur. Correct catheter position in the vein can be easily ascertained with X-ray or cross-sectional CT imaging. In this report, we describe the case of a 77-year-old patient on chronic hemodialysis via catheter due to arteriovenous fistula dysfunction. We placed a cuffed-tunneled hemodialysis catheter in the left internal jugular vein...
September 17, 2018: Blood Purification
Carlo Alfieri, Anna Regalia, Francesca Zanoni, Simone Vettoretti, Mario Cozzolino, Piergiorgio Messa
Secondary hyperparathyroidism (SHPT) is a frequent condition in the presence of chronic kidney disease (CKD). In CKD patients, SHPT is reported to increase both morbidity and mortality, especially cardiovascular. The difficulty in the treatment of SHPT in clinical practice is frequently encountered from a not always adequate conduct of the clinicians and a common non-compliance to the therapy of CKD patients. In this review, the greatest difficulties from clinicians and CKD-patients' point of view in the treatment of SHPT will be addressed, with particular attention to those related to dialysis features, nutritional habits, and medical therapy...
September 17, 2018: Blood Purification
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