Blood Purification最新文献

Introduction: Intravascular hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), associated with adverse outcomes such as kidney failure and increased mortality. There is wide variability in the cited incidence of this complication. This survey study aimed to characterize the variability in hemolysis monitoring practices across ECMO centers.

Methods: The survey, distributed via the Extracorporeal Life Support Organization (ELSO) newsletter, received 26 responses from various healthcare professionals, including nurses, perfusionists, respiratory therapists, and physicians. Respondents represented both pediatric and adult ECMO units, primarily from academic centers in the USA (46%).

Results: Findings revealed that 92% of these centers use centrifugal pumps, with heparin and bivalirudin being the preferred anticoagulants. While 68% of respondents reported having a standard protocol for hemolysis monitoring, the specific protocols varied widely. Plasma-free hemoglobin was the most commonly monitored laboratory test. Definitions for what were considered significant hemolysis varied as well and were primarily identified by red urine and elevated plasma hemoglobin levels. Interventions to address hemolysis included adjusting pump speed, repositioning cannulas, replacing pump heads or oxygenators, and performing plasmapheresis.

Conclusion: The study highlights the variability in hemolysis monitoring practices among ECMO centers. Further research is warranted to establish optimal monitoring protocols to detect and potentially treat the complication of hemolysis.

Introduction: Sleep disturbances are common in hemodialysis (HD) patients. We examined the excessive ultrafiltration rate (UFR), which is associated with poor outcomes, for its possible impact on sleep quality.

Methods: Only oligo-anuric patients with a three-times-weekly HD schedule were included in the study. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and a score >5 indicated poor sleepers. Ultrafiltration values refer to the month preceding the PSQI survey. Patients were divided into three categories: optimal UFR group (<10 mL/kg/h), borderline UFR group (10-13 mL/kg/h), and high UFR group (≥13 mL/kg/h).

Results: A total of 102 patients were included, with a median age of 60 (46-67) years. Median dialysis vintage was 44.5 (22-77) months. Average interdialytic weight gain (IDWG) percentage was 4.7 (3.7-5.7) and UFR was 11.6 ± 3.5 mL/kg/h. A total of 37 patients (36.3%) had optimal UFR, 29 patients (28.4%) had borderline UFR, and 36 patients (35.3%) had high UFR. Average PSQI score was 7 (4-10) points and 61 patients (59.8%) was identified as poor sleepers. Mean UFR was 11.7 ± 3.4 mL/kg/h in poor sleepers and 11.5 ± 3.7 mL/kg/h in non-poor sleepers (p = 0.819). PSQI score and poor sleeper prevalence were not significantly different between UFR groups. There was no significant correlation between PSQI and UFR (p = 0.325). In multivariate regression analysis, UFR was not an independent predictor of sleep quality. Additionally, younger age and a long HD vintage were independent predictors of high UFR.

Conclusion: Excessive and rapid fluid removal does not constitute a risk for poor sleep quality. Also, current findings underscore the increased frequency and complexity of sleep disorders in dialysis patients.

Introduction: Continuous renal replacement therapy (CRRT) is often performed for critically ill patients in intensive care units (ICUs), but its optimal indication and settings have yet to be determined. Thus, we aimed to describe the current status of CRRT in Japan through a multicenter retrospective observational study.

Methods: Adult ICU patients receiving CRRT at 18 tertiary hospitals in Japan (up to 100 patients from each hospital over the past year) were retrospectively enrolled. Patients receiving CRRT for <24 h or intermittent renal replacement therapy together with CRRT were excluded. The primary outcomes were the temporal changes in the electrolyte levels, acid-base balance, and uremia-related small solute concentrations. The secondary outcomes included potassium (K) and phosphate (P) supplementations during CRRT.

Results: Altogether, 1,045 patients were enrolled. The median CRRT duration and dose were 4.4 days and 17.3 mL/kg/h, respectively. The electrolyte levels, acid-base balance, and uremia-related small solute concentrations returned to normal by day 4 of treatment. A total of 732 (70.0%) patients received K supplementation, and only a few patients had hypokalemia until day 5. Moreover, 414 (39.6%) patients received P supplementation, and approximately 30%-50% of the patients had hypophosphatemia until day 5.

Conclusion: The CRRT dose in Japan was lower than that was recommended by the Kidney Disease: Improving Global Outcomes guideline. The electrolyte level abnormalities and acid-base imbalances of the studied patients were improved within 72-96 h of CRRT. Contrarily, K and P supplementations were common, indicating that the current CRRT solutions need to be modified.

Introduction: High mortality rates among maintenance hemodialysis (MHD) patients necessitate more precise predictive tools. Existing models are limited by the accuracy and clinical usability. This study aimed to construct a precise and user-friendly machine learning (ML)-based mortality risk predictive model for MHD patients.

Methods: A total of 601 MHD patients from Shantou Central Hospital were enrolled in this study. Clinical and laboratory data were meticulously gathered and assessed. Patients were divided randomly into Training (70%) and Test (30%) cohort. Six types of ML algorithms based predictive models were constructed for prognostic prediction. The predictive accuracy of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Additionally, an online predictive model application was developed for practical clinical application.

Results: The Training and Test cohort exhibited comparable demographic and clinical traits. Age, body mass index, hemoglobin, cholesterol, aspartate aminotransferase, and serum albumin levels emerged as significant independent predictors of prognosis. The Extreme Gradient Boosting (XGBoost) based model predictive performance measures included with AUROC 0.831 and AUPRC 0.310 in the Test cohort. The XGBoost-based model was selected as the definitive predictive tool and was made accessible via a web application.

Conclusion: We successfully developed a machine ML predictive model to predict the risk factors of MHD patients, which was then integrated into a user-friendly web application. This predictive tool could help identify MHD patients at high risk of mortality in clinical practice.

Introduction: Sepsis and septic shock frequently lead to acute kidney injury and the need for continuous renal replacement therapy (CRRT). The oXiris hemofilter has cytokine- and endotoxin-adsorptive properties that may improve outcomes, but evidence remains inconclusive. This study compared the clinical outcomes of septic intensive care unit (ICU) patients treated with CRRT using oXiris versus standard filters.

Methods: We conducted a retrospective observational study at a tertiary ICU in Istanbul between January 2019 and June 2024. Adult septic patients requiring CRRT within 24 h of ICU admission were included. Patients were treated with either oXiris or standard CRRT filters (M-100/M-150) for ≥16 h. The primary endpoint was ICU mortality; secondary endpoints included ventilator-free days (VFDs), ICU length of stay, and trends in inflammatory and biochemical markers.

Results: A total of 360 patients were analyzed (133 oXiris, 227 standard filters). Despite higher baseline sequential organ failure assessment (SOFA) scores, c-reactive protein (CRP), procalcitonin (PCT), and lactate in the oXiris group, ICU survival was significantly higher (61.7% vs. 48.9%, p = 0.019). After adjustment, oXiris use remained independently associated with improved survival (odds ratio 1.68, 95% confidence interval 1.09-2.60, p = 0.020). Total CRRT duration was markedly shorter in the oXiris group (56.4 vs. 107.4 h, p < 0.001). VFDs were similar between groups. Inflammatory markers (CRP, PCT) remained elevated in oXiris patients through day 5, while hemodynamic stabilization (lactate decline, norepinephrine reduction) was more pronounced. Platelet counts decreased in both groups without recovery.

Conclusion: Our study demonstrated that patients with sepsis treated using the oXiris filter exhibited significantly higher ICU survival rates, despite higher mechanical ventilation duration and ICU length of stay. However, persistent elevations in CRP and PCT, along with thrombocytopenia, suggest that these markers may not fully reflect therapeutic response. While oXiris use was associated with reduced ICU mortality, further randomized trials are needed to confirm its efficacy and account for potential confounders.

Introduction: Reducing dialysate flow (Qd) to 400 mL/min has proven to be sufficient, safe, and effective in meeting dialysis adequacy requirements in adults, with the added advantage of decreasing water consumption per dialysis session. Expanded hemodialysis (HDx), which uses dialyzers with membranes capable of enhanced clearance of medium-sized molecules due to expanded pore capacity, has higher efficiency and reduces the importance of the dialysate-to-blood flow ratio (Qd/Qb) for molecule removal. The objective of this study was to evaluate dialysis effectiveness by analyzing the reduction rate of medium-sized molecules in patients weighing ≤70 kg, comparing Qd 400 mL/min vs. 500 mL/min in HDx using Theranova® membrane.

Methods: A post hoc analysis of the COREXH study population was performed. This observational, analytical, retrospective cohort study included 23 patients, of whom 11 (47%) had Qd 400 mL/min and 12 (52.1%) had Qd 500 mL/min.

Results: No statistically significant differences were observed in the reduction rate of medium-sized molecules between the Qd 400 mL/min and 500 mL/min groups. Additionally, water consumption was lower in the Qd 400 mL/min group, with an average saving of 24 L per patient per session and 13,824 L over 12 weeks.

Conclusion: Using Qd 400 mL/min in HDx vs. 500 mL/min did not affect dialysis effectiveness in terms of molecule reduction rates and resulted in substantial water savings in Qd 400 mL/min group.

Introduction: The selective cytopheretic device (SCD) is a cell-directed extracorporeal therapy approved for use in children with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) with sepsis/sepsis-like conditions. We compared outcomes for children treated with SCD to a contemporary cohort of children treated with CRRT alone.

Methods: Secondary analysis and comparison of patients ≤22 years old and ≥10 kg from a multicenter registry of patients receiving CRRT for AKI and/or fluid overload (WE-ROCK; 2015-2021) to patients from two multicenter, prospective, interventional studies of children with AKI and multiple organ dysfunction (MODS) receiving SCD (SCD-PED-01/SCD-PED-02; 2016-2022).

Results: Eighteen patients in the SCD cohort were compared to 178 in the CRRT cohort. There were no differences between cohorts at CRRT ± SCD initiation. SCD patients had shorter CRRT duration (6 [3, 11] vs. 10 [5, 18] days, p = 0.013) and shorter ICU length of stay (LOS) in survivors (16 [11, 25] vs. 27 [16, 46] days, p = 0.012). Survival to ICU discharge or day 60 was 94% in the SCD cohort vs. 74% in the CRRT cohort (p = 0.079). A Bayesian analysis demonstrated a >99% probability of improved survival with SCD. A sub-analysis in septic patients demonstrated greater survival (100% vs. 69%, p = 0.032), shorter CRRT duration (5 [3, 7] vs. 11 [6, 17] days, p = 0.006) and reduced ICU LOS in survivors (21 [10, 25] vs. 27 [16, 45] days, p = 0.027) in SCD-treated patients.

Conclusions: The addition of SCD therapy in children with AKI and MODS receiving CRRT may be beneficial, though larger prospective studies are needed.

Background: 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.

Summary: This review explores the complex and dynamic interactions among poisons, patients, and EBPT and describes specific poisonings where EBPT may be indicated.

Key messages: 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.

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.