The Effect of Citrate on Clot Formation, Dialyzer Reuse, and Anemia in Hemodialysis Patients
Conclusion: During citrate dialysis in chronic HD patients, heparin can be completely avoided. The electrolyte levels, the adequacy of dialysis, and hemoglobin can be maintained without significant adverse events.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 13, 2018 Category: Hematology Source Type: research

Different Effect of Hemodialysis on Function of Human Arterial and Venous Endothelial Cells
Conclusions: Hemodialysis induces the inflammatory, procoagulant, and profibrinolytic activity of VEC, whereas suppression of AEC is observed at the same time. Video Journal Club ‘Cappuccino with Claudio Ronco’ at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 13, 2018 Category: Hematology Source Type: research

Association of Central Venous Oxygen Saturation Variability and Mortality in Hemodialysis Patients
Conclusion: High ScvO2 variability during dialysis is associated with increased all-cause mortality.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Tracking Arteriovenous Fistula Maturation: A Novel Approach
Conclusion: Our results indicate the potential utility of ScvO2 and eUBBF to track the hemodynamic response to AVF maturation. To what extent these insights translate into shortening of the time between AVF creation and successful cannulation warrants further investigations.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Difficult Patient Behavior in Dialysis Facilities
Difficult behavior exhibited by dialysis patients is a spectrum that includes nonadherence, verbal or physical abuse, and threatening acts. Such behaviors may lead to harmful consequences to the patient, other patients, the facility, and staff and can culminate in involuntary discharge. It is important to recognize that these “difficult behaviors” may be due to underlying psychosocial or medical issues, which places an onus on care providers to explore further. According to the Conditions for Coverage (CfC) for dialysis facilities, it falls upon the medical director to coordinate and oversee policies for patien...
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era
Conclusion: Previous studies on the effectiveness of learning showed that VR training applications are superior to traditional methods, such as text- or video-based training. However, no study has been undertaken in the context of dialysis. We believe that the implementation of VR training programs in clinical practice will be beneficial in improving the patient ’s proficiency, and thereby the quality and safety of PD.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Direct Effect of Septic Plasma in Human Cell Lines Viability
Conclusion: Humoral mediators in septic patients ’ plasma induce apoptosis. This fact suggests that apoptosis inhibitors should be investigated as future strategy to reduce sepsis-induced organ damages.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Impact of Hybrid Therapy Comprising Peritoneal Dialysis and Hemodialysis on Acute Cardiovascular Events
Conclusion: Hybrid therapy decreased acute cardiovascular events and improved systolic cardiac function in PD patients in the LEF group.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 6, 2018 Category: Hematology Source Type: research

Disaster Management in a Nephrology Service: Lessons Learned from Hurricane Maria
We describe our experience with patients with renal disease in an academic medical center.Summary: A comprehensive emergency response plan should be developed, shared and discussed with the team and the patients prior to the hurricane. The needs of the staff should not be ignored to ensure their ability to participate as responders. Physical damage to facilities, lack of basic services, shortage of disposable products, and the inability to get to treatment centers are the most common threats. Preemptive dialysis can avoid serious complications. A contingency plan to move patients to another center should be prearranged in ...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Sickle Cell Nephropathy in the Pediatric Population
Background: Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances, long-term chronic complications pose a greater challenge in the management of patients with SCD. In particular, sickle cell nephropathy (SCN) is associated with significant morbidity and mortality across all age groups. Furthermore, SCN is an understudied condition with relatively few symptoms and therefore requires close surveillance. In this review, we sought to explore the epidemiology, natural history, and treatment options for SCN with an emphas...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

End-Stage Kidney Patients Require Hemodialysis Therapy Full Start
Recently the concept that prescription of chronic hemodialysis (HD) start should be tailored based on residual renal function (RRF) and urine output (UO) has been revived from the past and called infrequent or incremental dialysis. It mainly consists in prescribing 1 or 2 HD sessions per week instead of what has become the standard thrice-weekly HD. It is both surprising and fascinating that almost 60 years after the first end-stage kidney disease patient was treated by Scribner et al. [Trans Am Soc Artif Intern Organs 1960; 6: 114 –122], the nephrology community still questions the best way to start HD therapy. This...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Body Fluids in End-Stage Renal Disease: Statics and Dynamics
Background: Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes.Summary: The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, comprom...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Dialysate Calcium Levels: Do They Matter?
Background: Calcium (Ca) is an essential element that plays a critical role in many biological processes. In dialysis patients, the regulation of Ca balance is highly complex, given the absence of kidney function, endocrine disturbances and the use of drugs such as phosphate binders, vitamin D analogues, and calcimimetics. Also, the use of different dialysate Ca (DCa) baths has profound effect on Ca balance, which depends both on the difference between the Ca concentration in the bath and the serum of the patients, as on the ultrafiltration volume.Summary: The choice of DCa may have important short- and long-term consequen...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Best Vascular Access in the Elderly: Time for Innovation?
This article discusses the arteriovenous fistula creation in the elderly, highlights the factors necessary for successful fistula creation, and describes the 2 innovative techniques that can be used to provide a robust platform for successful fistula creation in this population.Blood Purif (Source: Blood Purification)
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Recognizing Common Skin and Soft Tissue Infections in the Nephrology Clinic
Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the conditions causing the renal failure as well as complications of treatment and renal failure ’s innate effects on patient health. These infections have a significant impact on patient morbidity, increased hospital and procedural demands, and the cost of health care. Many renal failure patients are seen regularly by their nephrology clinic caregivers due to the need for frequent dialysis a nd transplant monitoring. Familiarity with common skin and soft tissu...
Source: Blood Purification - December 5, 2018 Category: Hematology Source Type: research

Risk Factors of Central Venous Catheter-Related Bloodstream Infection for Continuous Renal Replacement Therapy in Kidney Intensive Care Unit Patients
Conclusions: The incidence of CRBSI in our kidney ICU was 3.7%. Central venous CRBSI for CRRT was associated with catheterization of the femoral vein, long catheter indwelling time, compromised immune function and high APACHE II scores. Understanding pathogens and risk factors for central venous CRBSI in kidney ICU can help doctors prevent and treat CRBSI earlier.Blood Purif (Source: Blood Purification)
Source: Blood Purification - November 28, 2018 Category: Hematology Source Type: research

Increased Frequency of In-Center Hemodialysis as Rescue Therapy: Impact on Hospitalization for Acute Cardiovascular Events
Conclusion: In-center FHD may decrease acute cardiovascular events.Blood Purif (Source: Blood Purification)
Source: Blood Purification - November 22, 2018 Category: Hematology Source Type: research

The Association of Longitudinal Serum Uric Acid and All-Cause Mortality in Incident Peritoneal Dialysis Patients
Conclusion: Both TA-UA #x3c; 6 and ≥8 mg/dL increased the all-cause mortality in incident PD patients.Blood Purif (Source: Blood Purification)
Source: Blood Purification - November 21, 2018 Category: Hematology Source Type: research

Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine?
Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period....
Source: Blood Purification - November 16, 2018 Category: Hematology Source Type: research

Comparison of the Accuracy of the Novel PrisMax Continuous Renal Replacement Therapy System to the Classic Prismaflex System
Conclusion: The PrisMax CRRT device outperforms its predecessor with regard to dose delivery and accuracy.Blood Purif (Source: Blood Purification)
Source: Blood Purification - November 14, 2018 Category: Hematology Source Type: research

Continuous Veno-Venous Hemodialysis Using the Cardio-Renal Pediatric Dialysis Emergency Machine < sup > TM < /sup > : First Clinical Experiences
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 (6.5 and 8 Ch). The median prescribed Qb was 17 mL/min (IQR 10–29.5), with a median Qd of 10 mL/min. C...
Source: Blood Purification - October 31, 2018 Category: Hematology Source Type: research

Plasmapheresis Combined with Continuous Plasma Filtration Adsorption Rescues Severe Acute Liver Failure in Wilson ’s Disease before Liver Transplantation
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. H ere, 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 t...
Source: Blood Purification - October 25, 2018 Category: Hematology Source Type: research

Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients
Conclusions: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 25, 2018 Category: Hematology Source Type: research

Presepsin and Procalcitonin Levels as Markers of Adverse Postoperative Complications and Mortality in Cardiac Surgery Patients
Conclusions: Presepsin and ­procalcitonin seem to have comparable predictive value for ­adverse renal, cardiovascular, and respiratory outcome in cardiac surgery patients. Also, presepsin possesses a better predictive value for in-hospital, 30-days, and 6-months mortality.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 18, 2018 Category: Hematology Source Type: research

Is Expanded Hemodialysis an Option to Online Hemodiafiltration for Small- and Middle-Sized Molecules Clearance?
Conclusions: We conclude that HDx is not inferior to online hemodiafiltration in the clearance of small and middle molecules and could be superior in the clearance of larger middle molecules.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 12, 2018 Category: Hematology Source Type: research

Introduction to Extracorporeal Multiple Organ Support
Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 10, 2018 Category: Hematology Source Type: research

Calculating Standard Kt/V during Hemodialysis Based on Urea Mass Removed
Conclusion: This work provides a novel approach for calculating stdKt/V during HD and strengthens the theoretical understanding of stdKt/V.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 8, 2018 Category: Hematology Source Type: research

Effect of Increased Convection Volume by Mid-Dilution Hemodiafiltration on the Subclinical Chronic Inflammation in Maintenance Hemodialysis Patients
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. Primary outcome was the ch...
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Reply to Dr. Vassallo et al. (ms No. 201807012): Regional Citrate Anticoagulation During Coupled Plasma Filtration and Adsorption May Increase Survival in Septic Shock
Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Regional Citrate Anticoagulation During Coupled Plasma Filtration and Adsorption May Increase Survival in Septic Shock
Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Plasmapheresis Therapy in Kidney Transplant Rejection
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. Early diagnosis and precise treatment would reduce morbi...
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

The Incidence Prognosis and Risk Factors of Cognitive Impairment in Maintenance Haemodialysis Patients
Conclusion: CI is one of the most common complications in MHD patients.  The mortality is high in patients who had CI. Education status, post-dialysis diastolic pressure and spKt/V are independent risk factors for CI in MHD patients.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Free Pentosidine Assessment Based on Fluorescence Measurements in Spent Dialysate
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. The average free pe...
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

A New Series of Sorbent Devices for Multiple Clinical Purposes: Current Evidence and Future Directions
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 considere...
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

The Safety and Efficacy of Regional Citrate Anticoagulation in Albumin-Assisted Liver Dialysis for Extracorporeal Liver Support in Pediatric Patients
Conclusion: RCA provides safe and effective anticoagulation for pediatric LF patients requiring ELS.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

International Survey on the Management of Acute Kidney Injury and Continuous Renal Replacement Therapies: Year 2018
Conclusions: KDIGO appeared to be widely applied. The use of novel biomarkers has also emerged in recent years even if some consistent cost-benefit evidence is still lacking. There is a trend of increased awareness about AKI and extracorporeal treatments seem to be increasingly applied, when compared to previous surveys. Educational efforts and AKI management standardization still appear to be a fundamental aspect to harmonize therapeutic approaches and improve patients ’ outcomes.Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Acknowledgement to Reviewers
Blood Purif 2018;46:359 –360 (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Contents Vol. 46, 2018
Blood Purif 2018;46:I –VI (Source: Blood Purification)
Source: Blood Purification - October 5, 2018 Category: Hematology Source Type: research

Recovery Time after Hemodialysis Is Inversely Associated with the Ultrafiltration Rate
Conclusion: DRT is inversely associated with UFR in CHD patients. Whether a high UFR should be recommended to reduce the DRT needs to be elucidated through an adequate prospective randomized study.Blood Purif (Source: Blood Purification)
Source: Blood Purification - September 19, 2018 Category: Hematology Source Type: research

Expanding the Boundaries of Combined Renal Replacement Therapy for Non-Renal Indications
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. While the key role of hyperammonemia in the p...
Source: Blood Purification - September 18, 2018 Category: Hematology Source Type: research

Removal of Bilirubin with a New Adsorbent System: In Vitro Kinetics
Conclusion: Cytosorb ® seems a promising artificial liver support, thanks to its ability to adsorb bilirubin and its proven ability to modulate the cytokines involved in hepatic dysfunction.Blood Purif (Source: Blood Purification)
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

Serum Lipopolysaccharide-Binding Protein is Associated with Chronic Inflammation and Metabolic Syndrome in Hemodialysis Patients
Conclusions: Our study suggested that elevated plasma LBP was associated with metabolic syndrome and obesity. In addition, increased LBP level was correlated positively to markers of inflammation, and sCD14 levels.Blood Purif (Source: Blood Purification)
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

Optimal Prescriptions of Continuous Renal Replacement Therapy in Neonates with Hyperammonemia
Conclusion: This study suggested that CRRT could be a therapeutic option for neonates with IEM. However, it is necessary to raise the UFR above 4,000 mL/h/1.73 m2 in patients with high initial ammonia level.Blood Purif (Source: Blood Purification)
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

Anatomy Revisited: Hemodialysis Catheter Malposition into the Chest
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. Malpositioning of the catheter led to perforation of the great veins and migration of the catheter tip into the chest. It is important to be aware of the risk of potential incorrect positioning of dialysis catheters. Due to the stenosis and fragility of the vessel wall, perforation may occur. In cases of doubt, correct placement of large-bore catheters via the internal jugular vein should be verified ...
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

The Importance of Adherence in the Treatment of Secondary Hyperparathyroidism
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...
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus
Conclusions: PD may be acceptable, safe, and feasible for urgent-start dialysis in ESRD patients with diabetes.Blood Purif (Source: Blood Purification)
Source: Blood Purification - September 17, 2018 Category: Hematology Source Type: research

Acute Kidney Injury and Chronic Kidney Disease in the Elderly and Polypharmacy
Conclusion: Elderly patients who developed AKI had a higher number of hospitalizations (underlying frailty), were more likely to progress to more severe stages of CKD and to be affected by other non-renal pathologies (associated comorbidities) and to be given heavier pharmacological prescriptions (polypharmacy).Blood Purif 2018;46:332 –336 (Source: Blood Purification)
Source: Blood Purification - September 7, 2018 Category: Hematology Source Type: research

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review
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 st...
Source: Blood Purification - September 7, 2018 Category: Hematology Source Type: research

The Effect of Overhydration on Mortality and Technique Failure Among Peritoneal Dialysis Patients: A Systematic Review and Meta-Analysis
Conclusion: Overhydration, defined by a higher ratio of ECW/TBW, might be an independent predictor for all-cause mortality and technique failure among PD patients. However, more studies are needed to confirm this conclusion. Video Journal Club ‘Cappuccino with Claudio Ronco’ at https://www.karger.com/Journal/ArticleNews/223997?​sponsor=52Blood Purif 2018;46:350 –358 (Source: Blood Purification)
Source: Blood Purification - September 7, 2018 Category: Hematology Source Type: research

How Does Continuous Renal Replacement Therapy Affect Septic Acute Kidney Injury?
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. Third, the anticoagulant used ...
Source: Blood Purification - September 2, 2018 Category: Hematology Source Type: research