Introduction to Extracorporeal Multiple Organ Support
Blood Purif (Source: Blood Purification)
Source: Blood Purification - October 11, 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

Cytokine Clearances in Critically Ill Patients on Continuous Renal Replacement Therapy
Conclusion: Within the first 4 h of CRRT initiation, there is no significant difference between cytokine or solute clearance between CVVH and CVVHD.Blood Purif 2018;46:315 –322 (Source: Blood Purification)
Source: Blood Purification - August 14, 2018 Category: Hematology Source Type: research

Early Histological Changes in Post-Transplant Encapsulating Peritoneal Sclerosis
Blood Purif 2018;46:323 –325 (Source: Blood Purification)
Source: Blood Purification - August 14, 2018 Category: Hematology Source Type: research

Mortality Effects of Prolonged Hemoperfusion Therapy Using a Polymyxin B-Immobilized Fiber Column for Patients with Septic Shock: A Sub-Analysis of the DESIRE Trial
Conclusion: Prolonged polymyxin therapy might be associated with better clinical outcomes than 2-h polymyxin therapy in patients with septic shock. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=491744.Blood Purif 2018;46:309 –314 (Source: Blood Purification)
Source: Blood Purification - August 10, 2018 Category: Hematology Source Type: research

Does the Blood Pump Flow Rate have an Impact on the Dialysis Dose During Low Dialysate Flow Rate Hemodialysis?
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 0.46 ± 0.1 to 0.48 ± 0.08 and...
Source: Blood Purification - July 27, 2018 Category: Hematology Source Type: research

Depressive Symptoms in Dialysis: Prevalence and Relationship with Uremia-Related Biochemical Parameters
Conclusions: Using a  reliable, simple and fast tool, we found that depressive symptoms affect almost half of dialysis patients, particularly so the HD cohort. Severity of depressive symptoms seems related to serum levels of phosphorus possibly because depression affects compliance to therapy.Blood Purif 2018;46:286 –291 (Source: Blood Purification)
Source: Blood Purification - July 27, 2018 Category: Hematology Source Type: research

Understanding Left Ventricular Assist Devices
Conclusion: Management of these unique patients in the ICU is best accomplished with a multidisciplinary team that includes specialists in advanced heart failure, LVAD nurse coordinators and intensivists.Blood Purif 2018;46:292 –300 (Source: Blood Purification)
Source: Blood Purification - July 27, 2018 Category: Hematology Source Type: research

Microbiota Quality and Mitochondrial Activity Link with Occurrence of Muscle Cramps in Hemodialysis Patients using Citrate Dialysate: A Pilot Study
Conclusion: This first clinical study revealed a possible dysbiosis of microbiota and a mitochondrial dysfunction into HD patients with cramps under CD compared to patients without cramp.Blood Purif 2018;46:301 –308 (Source: Blood Purification)
Source: Blood Purification - July 27, 2018 Category: Hematology Source Type: research

Coupled Plasma Filtration Adsorption: A Multipurpose Extracorporeal Detoxification Therapy
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. After passing through the cartridge, the purified plasm...
Source: Blood Purification - July 4, 2018 Category: Hematology Source Type: research

Reducing Fibrinogen and Factor XIII Using Double-Filtration Plasmapheresis for Antibody-Mediated Rejection: Predictive Models
Conclusion: We established a model in order to predict fibrinogen and FXIII depletion after DFPP sessions; it may help clinicians supplement fibrinogen and/or FXIII when appropriate.Blood Purif 2018;46:239 –245 (Source: Blood Purification)
Source: Blood Purification - July 4, 2018 Category: Hematology Source Type: research

Removing the Incarcerated Tunneled Cuffed Venous Catheters: An Experience from a Single Center
Blood Purif 2018;46:246 –247 (Source: Blood Purification)
Source: Blood Purification - July 4, 2018 Category: Hematology Source Type: research

Continuous Veno-Venous High Cut-Off Hemodialysis Compared to Continuous Veno-Venous Hemodiafiltration in Intensive Care Unit Acute Kidney Injury Patients
Conclusion: HCO CVVHD is well tolerated and is as effective as HFM CVVHDF in clearance of solutes and removal of β2M. It induces neither protein loss nor overproduction of superoxide anion. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=489082.Blood Purif 2018;46:248 –256 (Source: Blood Purification)
Source: Blood Purification - July 4, 2018 Category: Hematology Source Type: research

Haemodialysis with Tinzaparin Versus Dialysate Citrate as Anticoagulation
Anticoagulation with citrate-containing haemodialysate (cHD) is an alternative to tinzaparin haemodialysate (tHD). The study investigated whether cHD would differ when changed from tHD. The same 18 patients were their own controls followed up with cHD for 5 months. LDL-cholesterol decreased at the end of a cHD session (p = 0.01). Neutrophils (p = 0.013) and monocytes (p = 0.007) dropped more during a cHD session. During the follow-up period of cHD, approximately 50% needed additional tinzaparin. Before the cHD session could start, there was a lower total cholesterol at 2  weeks (p = 0.014) and LDL-cholesterol at 1 mon...
Source: Blood Purification - July 4, 2018 Category: Hematology Source Type: research

A Simple and Cheap Hospitalization Risk Assessment Tool for Use in Hemodialysis Patients
Conclusion: Using a simple and cheap assessment tool in hemodialysis patients, we have identified patients at high risk for hospitalization rates and mortality. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=490544.Blood Purif 2018;46:265 –268 (Source: Blood Purification)
Source: Blood Purification - July 3, 2018 Category: Hematology Source Type: research

In Vitro Study of Endotoxin Adsorption by a Polymyxin B-Immobilized Fiber Column
Conclusions: The PMX-01R column showed sustained endotoxin adsorption for at least 24 h. This indicated that PMX-F columns would be capable of clinical endotoxin removal for 24 h.Blood Purif 2018;46:269 –273 (Source: Blood Purification)
Source: Blood Purification - July 3, 2018 Category: Hematology Source Type: research

Influence of Timing of Initiation and Volume of Processed Plasma on the Outcome of Septic Shock Patients Treated with Coupled Plasma Filtration and Adsorption
Conclusion: Our study confirms that intensity of CPFA, but not its timing of initiation, correlates with survival of septic shock patients.Blood Purif 2018;46:274 –278 (Source: Blood Purification)
Source: Blood Purification - July 3, 2018 Category: Hematology Source Type: research

The Novel PrisMax Continuous Renal Replacement Therapy System in a Multinational, Multicentre Pilot Setting
Conclusion: The PrisMax CRRT device is safe and outperformed its ’ previous generation counterpart in virtually all aspects. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=489213.Blood Purif 2018;46:220 –227 (Source: Blood Purification)
Source: Blood Purification - June 20, 2018 Category: Hematology Source Type: research

36th Vicenza Course on AKI & CRRT
Blood Purif 2018;46:163 –186 (Source: Blood Purification)
Source: Blood Purification - June 19, 2018 Category: Hematology Source Type: research

Ex vivo Rezafungin Adsorption and Clearance During Continuous Renal Replacement Therapy
Conclusion: Rezafungin is not removed by CVVH by membrane adsorption or via CLTM. Ultrafiltrate flow rates and hemodiafilter types are unlikely to influence rezafungin CLTM. No dosage adjustment of rezafungin is likely required for critically ill patients receiving CVVH.Blood Purif 2018;46:214 –219 (Source: Blood Purification)
Source: Blood Purification - June 14, 2018 Category: Hematology Source Type: research

Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion
Conclusion: Our in vitro testing suggests that HA cartridges carry an optimal level of biocompatibility and their use in HP is not associated with adverse reactions or signs of cytotoxicity.Blood Purif 2018;46:187 –195 (Source: Blood Purification)
Source: Blood Purification - June 8, 2018 Category: Hematology Source Type: research

Quantification of Internal Filtration in Hollow Fiber Hemodialyzers with Medium Cut-Off Membrane
Conclusions: MCO membrane provides significant amounts of IF due to the particular combination between hydraulic permeability of the membrane and reduced inner diameter of the fibers. High IF combined with enhanced sieving profile of MCO membrane leads to improved removal of a wider spectrum of uremia retention molecules in HDx, without requiring complex equipment.Blood Purif 2018;46:196 –204 (Source: Blood Purification)
Source: Blood Purification - June 8, 2018 Category: Hematology Source Type: research

Albumin Loss and Citrate Load in Pre-Dilution High Cut-Off-CVVHDF with Regional Citrate (18 mmol/L) and High Cut-Off CVVHD with Systemic Heparin: An in vitro Study
Conclusion: HCO-CVVHDF performed with regional anticoagulation  with 18 mmol/L citrate solution does not induce higher ­albumin transmembrane removal compared to HCO-CVVHD.Blood Purif 2018;46:205 –213 (Source: Blood Purification)
Source: Blood Purification - June 8, 2018 Category: Hematology Source Type: research

The Prevalence of Hepatitis B Virus Infection in a Population on Long-Term Hemodialysis
Blood Purif 2018;46:161 –162 (Source: Blood Purification)
Source: Blood Purification - May 4, 2018 Category: Hematology Source Type: research

Disorders of Lipid Metabolism in Chronic Kidney Disease
Cardiovascular disease (CVD) is the leading cause of death in chronic kidney disease (CKD). One of the most important pathophysiological mechanisms for CVD in patients with CKD is the widespread and possibly accelerated formation of atherosclerotic plaques due to hyperlipidemia, uremic toxins, inflammation, oxidative stress, and endothelial dysfunction. Recent studies showed that the level of oxidized low-density lipoprotein cholesterol increases, and that high- ­density lipoprotein cholesterol dysfunction occurs as kidney function declines and inflammation becomes more prevalent. In this review, we aimed to discuss th...
Source: Blood Purification - April 27, 2018 Category: Hematology Source Type: research

Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury
Conclusion: In contrast to the native CRP, monitoring of PCT during HCO-CVVHD is less useful because it reflects the clearance of this marker and anti-inflammatory effectiveness of the method.Blood Purif 2018;46:153 –159 (Source: Blood Purification)
Source: Blood Purification - April 27, 2018 Category: Hematology Source Type: research

Lectin Affinity Plasmapheresis for Middle East Respiratory Syndrome-Coronavirus and Marburg Virus Glycoprotein Elimination
Conclusion: MERS-CoV (pseudovirus) and MARV soluble GPs are eliminated by LAP in vitro. Considering the high lethality and missing established treatment options, LAP should be evaluated in vivo. Especially early initiation, continuous therapy, and timed cartridge exchanges could be of importance.Blood Purif 2018;46:126 –133 (Source: Blood Purification)
Source: Blood Purification - April 26, 2018 Category: Hematology Source Type: research