Blood Purification最新文献

Introduction: Continuous renal replacement therapy (CRRT) is increasingly used in critical pediatric patients with acute kidney injury (AKI). The choice of anticoagulant is vital to minimize circuit clotting and bleeding complications. Regional citrate anticoagulation (RCA) is preferred for its safety profile, particularly in critically ill pediatric patients who are susceptible to bleeding.

Methods: A comprehensive literature search was conducted using PubMed, Google Scholar, and Cochrane databases following PRISMA guidelines. Keywords included "diluted citrate," "regional citrate anticoagulation," "continuous renal replacement therapy," "pediatrics," and "adverse effects." Studies were included if they involved neonates and pediatric patients, reported citrate concentration, and safety and efficacy outcomes of RCA in CRRT. Data were extracted on study characteristics, citrate concentration, circuit lifespan, metabolic and electrolyte disturbances, and other adverse effects.

Results: A total of 16 studies met the inclusion criteria. RCA was associated with fewer clotting events and a longer median circuit life compared to heparin. However, complications such as metabolic alkalosis, hypocalcemia, and hypernatremia were noted. In our single-center experience, dilute citrate anticoagulation was used in 16 pediatric patients undergoing CRRT, showing promising results with reduced clotting and prolonged circuit life. The modified pediatric citrate protocol presented aims to address complications by using a diluted citrate solution.

Conclusions: RCA is effective in prolonging circuit life and reducing clotting in pediatric CRRT. The modified pediatric citrate protocol presents a safer alternative by reducing the risk of metabolic and electrolyte disturbances. Ongoing monitoring of calcium and electrolyte levels is essential to mitigate potential complications. This protocol may standardize RCA use in pediatric CRRT, improving safety and outcomes for critically ill children with AKI.

Introduction: Regional citrate anticoagulation (RCA) serves as the first line of anticoagulants in continuous kidney replacement therapy (CKRT). Premature circuit clotting is associated with increased workload, costs, and adverse patient outcomes. Current evidence shows limited studies on the relationship between RCA protocols and circuit clotting in RCA CKRT. The study aimed to investigate the factors influencing filter lifetime that lead to premature circuit clotting, including citrate formulas employed during RCA in CKRT.

Methods: This retrospective cohort study was conducted at a single center and included patients receiving CKRT from February 2023 to September 2023. The primary outcome was the identification of factors associated premature circuit clotting. Secondary outcomes included circuit ionized calcium levels, citrate doses, blood transfusions, citrate formulations, and other variables that may impact filter clotting.

Results: A total of 199 filters from 97 patients were analyzed in this study. After exclusion of circuit termination due to non-clotting event, 38 filters experienced premature circuit clotting (lifetime ≤72 h), while 70 filters clotted after 72 h. The baseline characteristics and clinical outcomes were well balanced between the groups. In the multivariable analysis, only isotonic citrate formulations (RR 2.45, 95% CI: 1.17-5.14, p = 0.018) and corrected citrate doses (RR 0.48, 95% CI: 0.27-0.87, p = 0.016) exhibited statistically significant associations with filter premature clotting.

Conclusion: Different RCA prescriptions may affect filter lifetime and circuit integrity. Notably, the hypertonic RCA protocol was associated with a significantly longer filter lifetime compared to the isotonic RCA protocol. However, additional data from rigorously constructed randomized controlled trials are needed.

The 39th International Society of Blood Purification (ISBP) Congress, Honolulu, Hawaii, USA August 20-22, 2025 www.ISBP-online.org Accepted Abstracts for publication in Blood Purification Release date to Karger's Blood Purification: 2025-07-27 Abstract Reviewers: Connie M Rhee, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA. Rasheed Balogun, University of Virgina Health, Charlottesville, VA. Kamyar Kalantar-Zadeh, Harbor-UCLA Medical Center, Torrance, CA.

Introduction: The relationship between the triglyceride-glucose (TyG) index and mortality in hemodialysis patients remains uncertain. This study aimed to investigate the correlation between TyG index and all-cause mortality in initial hemodialysis patients in China.

Methods: 783 patients participated in the study and were grouped into quintiles according to the TyG index. Multivariate Cox models and subgroup analyses were utilized. Nonlinear correlations were explored using restricted cubic splines, and a two-piecewise Cox proportional hazards model was developed around the inflection point.

Results: During a median follow-up of 44 months, 231 (29.50%) patients occurred mortality. Multivariate Cox regression confirmed that both lower and higher TyG indices independently predicted all-cause mortality (all p < 0.05). The predictive value of a high TyG index for all-cause mortality remained consistent across age, sex, BMI, and diabetes subgroups. A restricted cubic spline unveiled a J-shaped relationship between the two variables in initial hemodialysis patients. A TyG index exceeding 8.83 exhibited a positive correlation with all-cause mortality (hazard ratio, 1.78; 95% CI: 1.27-2.46, p < 0.001).

Conclusions: A J-shaped relationship was identified between the TyG index and all-cause mortality in initial hemodialysis patients in China, with a threshold of 8.83 for all-cause mortality.

Selected Abstracts from the 43rd Vicenza Course AKI-CRRT-EBPT and Critical Care Nephrology.

Background: Hemodialysis is a water-intense procedure, needing large quantities of water for preparation of small volumes of dialyzate. The resulting large volumes of reject water are usually discarded. With the rising water crisis both in the USA and the world, it is essential to understand water utilization and identify ways to minimize its utilization and maximize the use of the reject water.

Summary: Unfortunately, water from the city sources cannot be used to produce dialyzate unless it undergoes further purification. This results in a large amount of reject water, which can be from 50 to 70% of total water use, resulting in an enormous waste of resources. A review of solutions for water sustainability is broadly classified into solutions that decrease water utilization and solutions for increased reject water utilization. Those that are aimed at decreasing water utilization were mainly based in innovations in technology - examples are NxStage PureFlow™SL, Aquaboss by Braun and AquaBPlus by Fresenius, and those that focused on increased reuse of RO reject water rely on data that it can be safely utilized for various purposes such as irrigation and flushing toilets. These strategies can be cost-effective. Although the need for sustainability has been recognized, there needs to be further awareness and participation among nephrologists to further this cause. In addition, there need to be policies put forward by the government that could encourage sustainability.

Key messages: Hemodialysis continues to heavily tax the environment. Although the need for sustainability has been recognized, there still remains a lot of work that needs to be done. Further buy-in is needed from all participating entities - nephrologists, dialysis manufacturers and organizations, and the government in order to safeguard our limited resources.

Introduction: The use of temporary-left ventricular assist devices (T-LVADs) for circulatory support in cardiogenic shock is increasing along with complications like acute kidney injury requiring kidney replacement therapy (KRT). While KRT is linked to mortality in cardiogenic shock, data on mortality in patients receiving both T-LVAD and KRT are limited.

Methods: We conducted a systematic review and meta-analysis, searching three databases from inception through December 30, 2023, for studies reporting on patients with concurrent T-LVAD and KRT support during cardiogenic shock. We performed random-effects meta-analyses, looking at in-hospital mortality as our primary outcome. Subgroup analysis was performed based on the continent, timing of KRT, and type of T-LVAD. Risk of bias was assessed with the Joanna Briggs Institute checklists and certainty of evidence with the GRADE approach.

Results: We included 35 studies after screening through 89 full-text articles, consisting of 2,277 individuals receiving T-LVAD and 722 (30.9%, 95% CI: 25.8-36.6) receiving concurrent KRT. In-hospital mortality was pooled across 6 studies, with 91 non-survivors (65.5%) among 139 individuals (95% CI: 57.2-72.9). Concurrent KRT and T-LVAD was associated with higher in-hospital (OR 3.48, 95% CI: 2.20-5.49) and overall mortality (OR 2.19, 95% CI: 1.01-4.76) compared to patients not on KRT. The proportion of patients on KRT was significantly (p interaction = 0.0004) larger in Europe (37.2%, 95% CI: 32.2-42.4) than North America (18.2%, 95% CI: 12.0-26.7). Region, type of T-LVAD, and publication year did not significantly impact any of the mortality outcomes.

Conclusion: Patients on concurrent KRT and T-LVAD suffer significantly greater odds of mortality compared to patients not receiving KRT during their hospital admission. A substantial proportion of patients receiving T-LVADs require KRT. Further studies with head-to-head comparisons between KRT and non-KRT treatment arms are warranted to confirm our findings, in addition to identifying at-risk populations that require KRT and potential interventions to improve survival in this subset of patients.

Introduction: Survival is a core outcome of hemodialysis (HD) therapy. Expanded hemodialysis (HDx) enabled by Theranova dialyzer increases clearance of medium-sized molecules and was reported to improve various patient-reported outcomes compared to HD using high-flux membranes, but the impact on survival is unclear. Herein, we evaluated the risk of death for HDx versus high-flux HD over a 4-year follow-up period.

Methods: This is a multicenter, retrospective cohort study in adult prevalent chronic HD at Renal Care Services - Colombia starting between September 1, 2017, and November 30, 2017, with follow-up for up to 4 years. The sociodemographic and clinical characteristics of all patients were summarized descriptively. The Fine-Gray subdistribution hazard model was employed to evaluate the sub-hazard ratio of factors associated with time to death from causes other than COVID-19; death attributable to COVID-19 was considered as a competing risk. Sensitivity analyses included Cox proportional hazards model, extended Cox regression, and Cox regression after adjusting for imbalances between cohorts using the inverse probability of treatment weighting method.

Results: We evaluated 1,092 patients, 559 in HDx cohort and 533 in high-flux HD cohort; the mean age 61 years; 42% had diabetes, and 19% had cardiovascular disease. HDx using the Theranova dialyzer had a protective effect with reduction of mortality risk when controlling for confounding variables, SHR = 0.79 [95% CI: 0.62-0.98, p = 0.035]. Sensitivity analyses also showed a statistically significant beneficial effect of HDx versus high-flux HD.

Conclusions: HDx enabled by Theranova dialyzer was associated with an approximately 21% reduction in mortality risk compared to treatment with high-flux HD in patients followed for up to 4 years. It would be desirable for these very promising results to be corroborated by a randomized controlled trial, with sufficient follow-up time to investigate the effect described in this study.