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Blood Purification

Paik Seong Lim, Yu-Kang Chang, Tsai-Kun Wu
BACKGROUND: In hemodialysis (HD) patients, impaired gut barrier and alteration in microbiota in the gut is thought to increase the risk of bacterial translocation and chronic inflammation. Lipopolysaccharide-binding protein (LBP) is an acute-phase reactant that mediates immune responses triggered by microbial products. Our aim is to investigate the relationship between circulating levels of LBP, and various metabolic and inflammatory markers in HD patients. Besides, we also aim to determine its relationship among -patients with different body mass index...
September 14, 2018: Blood Purification
Claudia Gemelli, Aurora Cuoghi, Stefania Magnani, Mauro Atti, Davide Ricci, Antonio Siniscalchi, Elena Mancini, Stefano Faenza
BACKGROUND/AIMS: Many potentially toxic molecules accumulate in the blood during hepatic dysfunction. In clinical practice, it is very difficult to remove bilirubin, the most widely studied toxin, and particularly the unconjugated form, strongly albumin-bound. The aim of this in vitro study was to assess irreversible bilirubin adsorption as a protein-bound compound marker, using Cytosorb® (Cytosorbents Corp.), a new hemoadsorption device designed to remove cytokines. METHODS: We performed 4 in vitro experiments, dynamic and static, with different albumin-bilirubin solutions...
September 14, 2018: Blood Purification
Jeong Yeon Kim, Yeonhee Lee, Heeyeon Cho
BACKGROUND/AIMS: The aim of this study was to evaluate patients' outcomes, determine the prescriptions of continuous renal replacement therapy (CRRT) that effectively reduce serum ammonia levels, and analyze the prognostic factors in neonates with hyperammonemia. METHODS: The medical records of 12 Korean neonates with inborn error of metabolism (IEM) who underwent CRRT for hyperammonemia were retrospectively analyzed. RESULTS: All patients received continuous venovenous hemodiafiltration...
September 14, 2018: Blood Purification
Ying Shu, Jing Liu, Xiaoxi Zeng, Hyokyoung G Hong, Yi Li, Hui Zhong, Liang Ma, Ping Fu
BACKGROUND: Overhydration is common among peritoneal dialysis (PD) patients and can affect PD-related outcomes. This paper aims to systematically investigate whether bioimpedance-assessed overhydration is a predictor for mortality and technique failure in PD patients. METHODS: We conducted a systematic review and meta-analysis of cohort studies on overhydration and prognosis in PD patients, strictly complying with the Preferred Reporting Items for Systematical Reviews and Meta-analyses...
September 6, 2018: Blood Purification
Marco Formica, Paolo Politano, Federico Marazzi, Michela Tamagnone, Ilaria Serra, Marita Marengo, Daniela Falconi, Maurizio Gherzi, Fabio Tattoli, Chiara Bottaro, Danilo Giuliano, Vittoria Tibaldi, Giovanni Carlo Isaia
BACKGROUND: Acute kidney injury (AKI) incidence is reported to be 10 times higher in aged people. Related to their higher prevalence of chronic kidney disease (CKD), older patients are at high risk of toxic effects driven by drugs. METHODS: The demographics, hospitalizations, visits to the Emergency Department, pharmacological therapy, and lab tests were analyzed in 71,588 individuals. RESULTS: Data showed a higher prevalence of AKI as well as CKD in the elderly as compared to the younger group, with an associated very high mortality...
September 3, 2018: Blood Purification
Anthony Bonavia, Andrew Groff, Kunal Karamchandani, Kai Singbartl
Cytokines play a critical role in coordinating and amplifying a host immune response to infection. The normal pattern of localized and systemic release of proinflammatory and anti-inflammatory cytokines varies on the basis of the disease process. A dysregulated cytokine response can lead to a hyper-inflammatory condition called a cytokine storm. This is believed to contribute to the pathophysiology of sepsis and septic shock, a condition carrying high morbidity and mortality in critically ill patients. Extracorporeal cytokine hemoadsorption is an emerging technology utilized in the treatment of dysregulated inflammatory states such as sepsis, although there is a paucity of clinical evidence supporting its outcomes benefits...
September 3, 2018: Blood Purification
Jingxiao Zhang, Jiakun Tian, Hongzhi Sun, Kumar Digvijay, Mauro Neri, Vinant Bhargava, Yongjie Yin, Claudio Ronco
Sepsis is the leading cause of acute kidney injury (AKI) in the intensive care unit. As the most common treatment of septic AKI, it is believed that continuous renal replacement therapy (CRRT) can not only maintain the water balance and excrete the metabolic products but also regulate the inflammation and promote kidney recovery. CRRT can remove the inflammatory cytokines to regulate the metabolic adaption in kidney and restore the kidney recovery to protect the kidney in septic AKI. Second, CRRT can provide extra energy supply in septic AKI to improve the kidney energy balance in septic AKI...
August 31, 2018: Blood Purification
Ling-Xin Chen, Sevag Demirjian, Suneel M Udani, Sharon A Trevino, Patrick T Murray, Jay L Koyner
BACKGROUND/AIMS: We sought to quantify any differences in cytokine clearance between continuous venovenous hemofiltration (CVVH-convective) compared to continuous venovenous hemodialysis (CVVHD-diffusive). METHODS: We conducted a 20 patient, multicenter, prospective, open-label randomized trial (CVVH or CVVHD) at continuous renal -replacement therapy (CRRT) initiation. Blood, urine, and effluent were collected at 0, 4, 24, and 48 h after initiation of CRRT. Serum electrolytes, cytokines levels, and clearances were measured...
August 14, 2018: Blood Purification
Gioacchino Li Cavoli, Antonio Amato, Rosalia Mongiovì, Onofrio Schillaci, Carlo Giammarresi, Luisa Bono, Rosa Turdo, Camillo Carollo, Carmela Zagarrigo, Franca Servillo, Barbara Oliva, Angelo Tralongo, Flavia Caputo
No abstract text is available yet for this article.
August 14, 2018: Blood Purification
Yu Kawazoe, Tetsuya Sato, Noriko Miyagawa, Yuta Yokokawa, Shigeki Kushimoto, Kyohei Miyamoto, Yoshinori Ohta, Takeshi Morimoto, Hitoshi Yamamura
BACKGROUND/AIMS: The optimal duration of hemoperfusion therapy with a polymyxin B-immobilized fiber column has not yet been verified. METHODS: This analysis examined whether hemoperfusion therapy with a polymyxin B-immobilized fiber column lasting longer than 2 h (prolonged polymyxin) improved outcomes for patients with septic shock compared to 2-h polymyxin therapy (sub-analysis of data from the DESIRE trial). RESULTS: The 2-h and prolonged polymyxin groups contained 22 and 14 patients, respectively...
August 10, 2018: Blood Purification
Luigi Cirillo, Roberta Cutruzzulà, Chiara Somma, Marco Gregori, Giuseppe Cestone, Chiara Pizzarelli, Alessandro Toccafondi, Francesco Pizzarelli, Pietro Claudio Dattolo
BACKGROUND: Depression is the most common psychiatric disorder in long-term dialysis patients and a risk factor for morbidity and mortality. Although there is a relevance of the issue in the dialysis setting, we still know little about possible relationships between depression and uraemia-related biochemical abnormalities. Our aims were to evaluate (1) the prevalence of depression in our haemodialysis (HD) and peritoneal dialysis (PD) population using a validated and easy-to-implement screening tool and (2) the association between depression and the main uraemia-related clinical and biochemical parameter changes...
July 26, 2018: Blood Purification
Pierre-Yves Durand, Carole Nicco, Didier Serteyn, David Attaf, Marvin Edeas
BACKGROUND/AIMS: Hemodialysis-associated muscle cramp (HAMC) is a common complication under citrate dialysate (CD) occurring in 30% of cases. Our objectives were to assess the gut microbiota quality, mitochondrial activity, and to investigate their possible relationship with HAMC. METHODS: Ten end-stage renal disease patients (78.9 ± 2.1 years) treated by hemodialysis (HD) with CD were enrolled and then classified according to the frequency of HAMCs: "frequent HAMCs group" (n = 5) and "absence of HAMCs group" (n = 5)...
July 26, 2018: Blood Purification
Nadia Aissaoui, Jerome Jouan, Melissa Gourjault, Benoit Diebold, Sofia Ortuno, Amer Hamdan, Christian Latremouille, Romain Pirracchio, Michiel Morshuis
BACKGROUND/AIMS: Long-term mechanical assist devices are now commonly used in the treatment of severe heart failure to unload the failing ventricle, maintain sufficient end-organ perfusion and improve functional capacity. Depending on the assisted ventricles, 3 categories of long-term assist devices are available: left ventricular assist device (LVAD), biventricular assist device and total artificial heart. Improvements in technology, especially the advent of smaller, durable continuous flow pumps, have led to the use of LVADs in a much broader population of patients in the last 10 years...
July 26, 2018: Blood Purification
Maxime Leclerc, Clémence Bechade, Patrick Henri, Elie Zagdoun, Erick Cardineau, Thierry Lobbedez, Maxence Ficheux
We conducted a prospective study to assess the impact of the blood pump flow rate (BFR) on the dialysis dose with a low dialysate flow rate. Seventeen patients were observed for 3 short hemodialysis sessions in which only the BFR was altered (300,350 and 450 mL/min). Kt/V urea increased from 0.54 ± 0.10 to 0.58 ± 0.08 and 0.61 ± 0.09 for BFR of 300, 400 and 450 mL/min. For the same BFR variations, the reduction ratio (RR) of β2microglobulin increased from 0.40 ± 0.07 to 0.45 ± 0.06 and 0.48 ± 0.06 and the RR phosphorus increased from 0...
July 26, 2018: Blood Purification
Chizuru Yamashita, Kazuhiro Moriyama, Daisuke Hasegawa, Yu Kato, Toshikazu Sakai, Takahiro Kawaji, Yasuyo Shimomura, Yasuyoshi Kurimoto, Mariko Nagata, Osamu Nishida
BACKGROUND: Polymyxin B-immobilized fiber (PMX-F) columns are used as therapeutic interventions for septic shock. The clinical efficacy has been reported for 2-h applications, but their ability to adsorb endotoxin over longer treatments has not been fully elucidated. We hypothesized that PMX-F columns are capable of endotoxin removal for more than 2 h. METHOD: We designed closed circuits incorporating either a PMX-F column with an 8.5-mL priming volume (PMX-01R) or a sham-control column, and used inactivated fetal bovine serum as the circulating perfusate...
July 3, 2018: Blood Purification
Muhammad Nauman Hashmi, Hammad Raza, Wael Elshazly, Fayez Hejaili, Abdullah Al Sayyari
OBJECTIVE: To develop a simple, objective, cheap scoring tool incorporating nutritional parameters and other variables to predict hospitalization and mortality among hemodialysis patients - a tool that could be utilized in low resource countries. METHODS: The following variables were scored according to severity into 0, 1, 2 or 3: BMI, functional capacity, HD vintage in years, serum albumin, serum ferritin, and the number of comorbid conditions (diabetes mellitus, hypertension, ischemic heart disease, cerebrovascular disease)...
July 3, 2018: Blood Purification
Giorgio Berlot, Stefano Falini, Virginia Negro, Antoinette Agbedjro, Ariella Tomasini, Fulvio Iscra, Francesco Bianco, Ugo Gerini, Giuliano Boscutti
BACKGROUND: The extracorporeal removal of mediators is a rescue strategy for septic shock patients, which is still under investigation. Several techniques are available: coupled plasma filtration and adsorption (CPFA) combines plasma processing with renal replacement therapy. METHODS: The study aimed to elucidate the role of both timing of initiation and intensity of treatment on the outcome, for which we retrospectively studied 52 patients. We collected the overall pre-CPFA time interval, starting from the first episode of hypotension in the wards and the volume of processed plasma (Vp), which we used as a proxy for intensity of treatment...
July 3, 2018: Blood Purification
Soo Min Jang, Grayson Hough, Bruce A Mueller
BACKGROUND/AIMS: To determine adsorption and transmembrane clearances (CLTM) of rezafungin, a novel long-acting echinocandin, in continuous venovenous hemofiltration (CVVH). METHODS: A validated ex vivo bovine blood CVVH model using polysulfone and AN69 hemodiafilters was used to evaluate urea and rezafungin CLTM at 3 different ultrafiltrate flow rates. Rezafungin adsorption to the CRRT apparatus was determined for each hemodiafilter. RESULTS: The sieving coefficient (SC) from CVVH with 3 different ultrafiltrate flow rates was 0 for both HF1400 and Multiflow-150 hemodiafilters, while urea SC was approximately 1 at all flow rates...
2018: Blood Purification
Thomas Jouve, Raphaël Marlu, Paolo Malvezzi, Landry Seyve, Jocelyne Maurizi, Pierre-Louis Carron, Benoît Polack, Lionel Rostaing
BACKGROUND/AIMS: Antibody-mediated rejection (AMR) is related to circulating donor-specific anti-human leukocyte antigen alloantibodies (DSAs). DSAs can be removed by apheresis, for example, double-filtration plasmapheresis (DFPP). However, DFPP removes some clotting factors (fibrinogen and factor XIII [FXIII]). METHODS: This was a prospective trial including 6 DSA-mediated AMR kidney transplant recipients. Patients received 2 cycles of 3-4 consecutive DFPP sessions followed by 1 injection of rituximab (break of 4-5 days between the 2 cycles)...
2018: Blood Purification
Gaetano La Manna, Gabriele Donati
Coupled plasma filtration adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit with a continuous renal replacement therapy. The circuit consists of a plasma filter, a resin/adsorbent cartridge and a haemofilter. It differs from many other types of extracorporeal therapies in that the upper part of the circuit can be considered a "closed loop". In this manner, the plasma separated by the plasma filter passes through an adsorbent cartridge containing a resin with high affinity to many cytokines, mediators and toxins/poisons...
2018: Blood Purification
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