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Tao Su, Qizhuang Jin, Zhongyuan Liu
BACKGROUND: Critically ill patients requiring renal replacement therapy (RRT) are at risk of disease-related bleeding. Systemic heparinization should be avoided. AN69ST, a polyethyleneimine-treated polyacrylonitrile (AN69) membrane hemofilter, can be primed with heparin, improving its local anticoagulative activity. Prolonged intermittent RRT (PI-RRT) is of shorter duration and cheaper, considered as an alternative to continuous RRT. This study was performed to compare the success rate of anticoagulant-free PI-RRT using AN69ST versus AN69 membrane hemofilter...
June 30, 2017: BMC Nephrology
M G Vossen, D Knafl, M Haidinger, R Lemmerer, M Unger, S Pferschy, W Lamm, A Maier-Salamon, W Jäger, F Thalhammer
Critically ill patients often experience acute kidney injury and the need for renal replacement therapy in the course of their treatment in an intensive care unit (ICU). These patients are at an increased risk for candidiasis. Although there have been several reports of micafungin disposition during renal replacement therapy, to this date there are no data describing the elimination of micafungin during high-dose continuous venovenous hemodiafiltration with modified AN69 membranes. The aim of this prospective open-label pharmacokinetic study was to assess whether micafungin plasma levels are affected by continuous hemodiafiltration in critical ill patients using the commonly employed AN69 membrane...
August 2017: Antimicrobial Agents and Chemotherapy
Vanessa Nseir, Antoine Rachas, Michelle Elias, Hélène Francois, Erika Nnang Obada, Hans Kristian Lorenzo, Bernard Charpentier, Antoine Durrbach, Séverine Beaudreuil
BACKGROUND: The optimal management of anticoagulation in hemodialyzed patients with a high risk of bleeding is controversial. METHODS: We compared premature termination of dialysis caused by clotting events between AN69ST membranes (G1) and 0.8 mmol/L citrate-enriched dialysate (G2). The number of sessions that had increased venous pressure (VP) and variations in urea-reduction ratio (URR) were analyzed. RESULTS: Six hundred and two sessions were analyzed in 259 patients: 22...
2017: Blood Purification
Weerachai Chaijamorn, Alexander R Shaw, Susan J Lewis, Bruce A Mueller
BACKGROUND/AIMS: To determine ceftolozane/tazobactam transmembrane clearances (CLTM) in continuous hemofiltration (CHF) and continuous hemodialysis (CHD) and to determine optimal ceftolozane/tazobactam dosing regimens for patients receiving continuous renal replacement therapy (CRRT). METHOD: Validated, ex vivo CHF and CHD bovine blood models using polysulfone (HF1400) and AN69 (Multiflow 150-M) hemofilters were used to evaluate adsorption and CLTM at different effluent flow rates...
2017: Blood Purification
C S Yang, Y Yang, L W Huang, X W Zhang, S Q Liu, H B Qiu
Objective: To investigate the condition of implementation of continuous renal replacement therapy (CRRT) in quality control center of critical care medicine. Methods: Questionnaire mails were issued to all of the quality control respondents to survey the application of CRRT in June 2015 from Jiangsu quality control center of critical care medicine. Results: Among the 69 quality control respondents, 62 were equipped with CRRT devices, and in 58 of which patients were treated with CRRT. There were 195 doctors and 253 nurses in 62 quality control respondents attended CRRT training at or above the provincial level; the proportions of hospitals in southern, central and northern regions of Jiangsu were 63%, 79% and 86% respectively with trained doctors (more than 2), and 34%, 38% and 43% respectively with trained nurses (more than 3)...
October 25, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Souad Lakbakbi, Alexandre Debrumetz, Christine Terryn, Jean Szymezak, Philippe Rieu, Philippe Nguyen
End-stage renal patients present a high risk of thrombosis and bleeding. Consequently, it is challenging to prevent clotting during hemodialysis. If a contact system induces thrombin generation in the extra corporeal circuit, recent data suggest a role of tissue factor (TF) in hemodialysis-associated thrombosis. Using a method of elution, we collected adhering cells to an acrylonitrile membrane layered by polythyleneimine (AN69-ST). Using optic microscopy and flow cytometry, we observed that adherent cells were mainly constituted by activated polymorphonuclear neutrophils (PMNs)...
August 2016: Thrombosis Research
Marta Ulldemolins, Ignacio Martín-Loeches, Mireia Llauradó-Serra, Javier Fernández, Sergi Vaquer, Alejandro Rodríguez, Caridad Pontes, Gonzalo Calvo, Antoni Torres, Dolors Soy
OBJECTIVES: This multicentre study aimed to describe the pharmacokinetics (PK) of piperacillin in critically ill patients with multiple organ dysfunction syndrome (MODS) receiving continuous venovenous haemodiafiltration (CVVHDF), to identify the sources of PK variability and evaluate different dosing regimens to develop recommendations based on clinical parameters. PATIENTS AND METHODS: Nineteen patients with MODS and CVVHDF receiving piperacillin/tazobactam were enrolled from three tertiary hospitals (95 plasma samples)...
2016: Journal of Antimicrobial Chemotherapy
Yoshitaka Hara, Yasuyo Shimomura, Tomoyuki Nakamura, Naohide Kuriyama, Chizuru Yamashita, Yu Kato, Taku Miyasho, Toshikazu Sakai, Shingo Yamada, Kazuhiro Moriyama, Osamu Nishida
Promising results have been reported with blood purification as adjuvant treatment; however, the immunological mechanisms remain unclear. We have been developing a new blood purification system for regulating excessive immune reactions in severe sepsis and septic shock using a granulocyte adsorbing column (Adacolumn [Ada]), and a cytokine-adsorbing hemofilter (AN69ST hemofilter [AN69]). Fresh porcine blood was circulated for 6 h in five experimental groups including Ada and AN69 to assess the effects of leukocyte adsorption, phagocytic activity and adhesiveness of granulocytes...
August 2015: Therapeutic Apheresis and Dialysis
Ying Zhou, Jenny-Marie T Wong, Omar S Mabrouk, Robert T Kennedy
Neuropeptides are an important class of neurochemicals; however, measuring their concentration in vivo by using microdialysis sampling is challenging due to their low concentration and the small samples generated. Capillary liquid chromatography with mass spectrometry (cLC-MS) can yield attomole limits of detection (LOD); however, low recovery and loss of sample to adsorptive surfaces can still hinder detection of neuropeptides. We have evaluated recovery during sampling and transfer to the cLC column for a selection of 10 neuropeptides...
October 6, 2015: Analytical Chemistry
Sebastian Hafner, Wolfgang Stahl, Theresa Fels, Karl Träger, Michael Georgieff, Martin Wepler
BACKGROUND: Regional citrate anticoagulation (RCA) is being increasingly used during continuous renal replacement therapy (CRRT) in intensive care units as an alternative to systemic heparin anticoagulation. However, due to its availability in a variety of solutions and dialysis systems, RCA is still considered a complex intervention, possibly leading to confusion and pitfalls in everyday practice. We therefore tested retrospectively if the introduction of RCA as a new anticoagulation strategy for CRRT was feasible and had not negatively impacted efficacy, safety, metabolic stability, filter lifetime, and cost-effectiveness compared to well-established systemic heparin...
2015: Journal of Intensive Care
Susan J Lewis, Lynn A Switaj, Bruce A Mueller
BACKGROUND/AIMS: To study transmembrane clearance (CLTM) and adsorption of tedizolid, a novel oxazolidinone antibiotic, in continuous hemofiltration (CVVH) and continuous hemodialysis (CVVHD). METHODS: In vitro CVVH/CVVHD models with polysulfone and AN69 hemodiafilters were used. Tedizolid CLTM during CVVH/CVVHD was assessed at various ultrafiltrate (Quf) and dialysate rates (Qd). Tedizolid adsorption was tested in a recirculating CVVH model over 4 h. RESULTS: In CVVH, CLTM did not differ between filter types...
2015: Blood Purification
Bin Yu, Lixia Liu, Dong Xing, Congcong Zhao, Zhenjie Hu
OBJECTIVE: To investigate the extracorporeal clearance rate of imipenem in severe infection patients in the mode of continuous vena-venous hemofiltration (CVVH) during continuous renal replacement therapy (CRRT), in order to approach if the concentration of imipenem in plasma could achieve effective levels of anti-infection, and to explore the effect of time and anticoagulation measure on imipenem clearance during CRRT treatment. METHODS: A prospective observational study was conducted...
May 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Yanling Yin, Congcong Zhao, Zhenjie Hu, Shuyan Wei, Yan Huo
OBJECTIVE: To evaluate whether AN69 ST membrane would prolong filter lifetime in continuous renal replacement therapy (CRRT) without anticoagulation in patients with high risk of bleeding. METHODS: A single-center, prospective, randomized, double-blind control trial with crossover design was conducted. From March 1st to December 31st in 2013, patients who were admitted to Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University meeting CRRT treatment indications, but could not receive systemic anticoagulation because of high risk of bleeding were studied...
May 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Michael L Bentley, Alan S Hollistera, Amanda C Hansenb, Jean A Smith, James S Cain
OBJECTIVE: Peramivir is a neuraminidase inhibitor having activity against various influenza A and B subtypes. The main route of elimination is the kidney and a dose reduction is justified for multiple-day therapy when the creatinine clearance is < 50 mL/min. Before the 2009 influenza pandemic, dosing guidelines did not exist for patients receiving continuous renal replacement therapy (CRRT). This case report provides data on the dialysis membrane saturation coefficient (SA) and pharmacokinetic parameters of peramivir in a 29-year-old female receiving continuous veno-venous hemodiafiltration (CVVHDF), a mode of CRRT...
December 2014: International Journal of Clinical Pharmacology and Therapeutics
Ana Cerqueira, Patricia Alexandra Martins, Berta Aguiar Carvalho, Manuel Pestana Vasconcelos
Adverse reactions during hemodialysis (HD) sessions although infrequent can be severe. We report two cases of recurrent adverse reactions to HD biocompatible synthetic membranes. Change to AN-69 dialyzer allowed subsequent uneventful HD sessions. This may be due to the surface treated membrane, which provides greater adsorption capacity and improved biocompatibility.
February 2015: Clinical Nephrology
Hiroaki Nakada, Tetsuya Kashiwagi, Yasuhiko Iino, Yasuo Katayama
BACKGROUND: AN69 dialyzer, a plate type dialyzer with a polyacrylonitrile membrane (PAN membrane) is reported to reduce symptoms in hemodialysis (HD) patients with complications such as poor nutritional status and peripheral arterial disease (PAD). Yet very few studies have investigated the long-term use of the PAN membrane or compared the solute-removal properties of the PAN membrane with those of the Type IV polysulfone membrane (PS membrane), the dialysis membrane most widely used...
2014: Journal of Nippon Medical School, Nippon Ika Daigaku Zasshi
M E Herrera-Gutiérrez, G Seller-Pérez, D Arias Verdu, C Jironda-Gallegos, M Martín-Velázquez, G Quesada-García
AN69 membrane is not suited for diffusion, with an suggested limit at 25 mL/min dialysate flow rate. When prescribing continuous hemodialysis this threshold must be surpassed to achieve. We designed a study aimed to check if a higher dose of dialysis could be delivered efficiently with this membrane. Ten ICU patients under continuous hemodiafiltration with 1.4 m(2) AN69 membrane were included and once a day we set the monitor to exclusively 50 mL/min dialysate flow rate and 250 mL/min blood flow rate and after 15 minutes measured dialysate saturation for urea, creatinine, and β 2-microglobulin...
2013: ISRN Nephrology
Takahiro Kuragano, Minoru Furuta, Yasushi Shimonaka, Aritoshi Kida, Mana Yahiro, Yoshinaga Otaki, Yukiko Hasuike, Akihide Matsumoto, Takeshi Nakanishi
PURPOSE: Hepcidin has been suspected to be associated with anemia of chronic disease, which is commonly observed in patients with maintenance hemodialysis (MHD). As almost of hepcidin is bounded to protein, it is essential to clarify which kind of dialysis membrane can remove it efficiently. METHODS: Ex vivo study: 50 mL of whole blood from healthy volunteers were circulated for 2 h in a microcircuit with mini-dialyzers (acrylonitrile-co-methallyl sulfonate (AN69) or polysulfone (PS)) without ultrafiltration...
October 3, 2013: International Journal of Artificial Organs
Patrick M Honore, Rita Jacobs, Olivier Joannes-Boyau, Jouke De Regt, Elisabeth De Waele, Viola van Gorp, Willem Boer, Lies Verfaillie, Herbert D Spapen
In recent years, after all the attention has been focused on the dose for continuous renal replacement therapy (CRRT) in sepsis and systemic inflammation response syndrome (SIRS), the relatively negative results of all those studies did urge our expectations on new approaches regarding CRRT in sepsis and SIRS. So far, after the failure of the major randomized studies on dose, attention is now drawn to new membranes that could better eliminate massive amounts of unbound mediators in wider spectrum and also in greater magnitude Nevertheless, for septic acute kidney injury, the recommended dose will remain 35 ml/kg/h until the IVOIRE (hIgh VOlume in Intensive Care) study will be published...
March 2013: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Isaac Desheng Liu, Kar-Hui Ng, Perry Yew-Weng Lau, Wee-Song Yeo, Pei-Lin Koh, Hui-Kim Yap
BACKGROUND: Initiating continuous renal replacement therapy (CRRT) in infants exposes them to the dual hemodynamic challenges of high circuit extracorporeal volumes and potential membrane reactions, in the case of acrylonitrile AN69 membranes. The use of the new Prismaflex HF20 membrane in hemodynamically unstable low-body-weight infants on inotropic support has not been reported. TREATMENT: We describe the use of the HF20 (Gambro Lundia AB, Lund, Sweden) membrane in four low-body-weight infants (2...
May 2013: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
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