Hemoperfusion in Trauma
Contrib Nephrol. 2023 Jun 1;200:1-11. doi: 10.1159/000527570. Online ahead of print.ABSTRACTMajor trauma care has seen significant improvements in early mortality, reflecting improvements in prehospital techniques for hemorrhage control and speed of access to specialized trauma centers. However, many patients then go on to die in the intensive care unit (ICU), and improvements in immediate trauma care are presenting intensivists with greater numbers of severely injured patients who might previously have died shortly after injury. It is theorized that, despite initial survival, these patients deteriorate due to massive rele...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Jack C Eldridge Yize I Wan John R Prowle Source Type: research
Rationale for Adsorption in Extracorporeal Blood Purification
Contrib Nephrol. 2023 Jun 1;200:1-11. doi: 10.1159/000527707. Online ahead of print.ABSTRACTA strong rationale supports the development of adsorption-based extracorporeal blood purification in conditions such as sepsis, acute kidney disease, uremia, and acute liver failure. The retention of compounds as a consequence of acute or chronic organ dysfunction might have detrimental effects. When a causative effect of an accumulated compound in a pathogenic condition is demonstrated, a rationale for the removal of this solute is also established. Adsorption is a mass transfer mechanism in which a solute chemically interacts with...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Thiago Reis F ábio Reis Ant ônio Fagundes Rog ério da Hora Passos Francisco de Assis Rocha Neves Source Type: research
Hemoperfusion in Cardiac Surgery and ECMO
Contrib Nephrol. 2023 Jun 1;200:1-12. doi: 10.1159/000527338. Online ahead of print.ABSTRACTExtracorporeal circulation (ECC) such as cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO) may induce a complex activation of the immune system. To date, strategies to mitigate this activation have failed to translate into meaningful improvement of clinical outcomes. Hemoperfusion is a blood purification technique, which relies on mass separation by a solid agent (hemoadsorption). It can be performed by adding a cartridge filled with adsorptive sorbent in the extracorporeal circuit. These devices have the theoreti...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Paul Abraham Vitor Mendes Matthias Kirsch Antoine Schneider Source Type: research
Monitoring Treatment, Risks and Side Effects
Contrib Nephrol. 2023 Jun 1;200:1-9. doi: 10.1159/000527344. Online ahead of print.ABSTRACTInflammation plays a key role in the pathophysiology of organ dysfunction in the critically ill patients and is triggered by an overwhelming host response resulting in the overproduction of various cytokines. Regaining immune homeostasis over the dysregulated immune response through broad removal of cytokines using extracorporeal blood purification therapies has recently gained increasing attention. Nonetheless, many questions remain regarding the appropriate monitoring treatment, its potential risks, and side effects. The CytoSorb b...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Zsolt Moln ár Jakub Szrama Katarzyna Sierakowska Source Type: research
Liver Support Techniques in Acute and Hyperacute Liver Failure
Contrib Nephrol. 2023 Jun 1;200:1-13. doi: 10.1159/000527343. Online ahead of print.ABSTRACTWith the growing prevalence of acute liver failure or acute-on-chronic liver failure, on the one hand, and the limited supply of liver organs for transplantation, on the other hand, it is critical to the design, validate, and implement devices that can provide extracorporeal liver support (ECLS) as the bridge to transplantation or potentially destination therapies. The number of attempts to generate ECLS devices has resulted in several options with various levels of impact on clinical outcomes. The described ECLS tools could be as s...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Sanjay Chaudhary Kianoush B Kashani Source Type: research
Hemadsorption in Critically Ill Children
Contrib Nephrol. 2023 Jun 1;200:1-10. doi: 10.1159/000529904. Online ahead of print.ABSTRACTApplication of extracorporeal blood purification in children is increasing with the improvement of technology and the broadening of indications in critically ill patients. Furthermore, novel devices are being made available with a miniaturized design to be applicable to pediatric machines and circuits. Current literature in the pediatric setting is essentially based on case series and observational studies. Novel prospective uncontrolled databases are underway, and the interest is growing in children, since the potential indications...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Pier Paolo Duchini Gabriella Bottari Akash Deep Zaccaria Ricci Source Type: research
Hemoperfusion in COVID-19
Contrib Nephrol. 2023 Jun 1;200:1-9. doi: 10.1159/000527583. Online ahead of print.ABSTRACTThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global emergency outbreak disease that devastatingly affected world public health and the economy. The pathogenesis of severe SARS-CoV-2 infection in humans has been linked to a strong immunological response that leads to a hyperinflammatory state, or "cytokine storm," which is a sepsis-like state resulting in capillary leakage, microvascular and macrovascular thrombosis, and multiple organ destruction. In recent years, there have been several case series...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Tanat Lertussavavivat Nattachai Srisawat Source Type: research
Hemoperfusion: Indications, Dose, Prescription
Contrib Nephrol. 2023 Jun 1;200:1-10. doi: 10.1159/000529294. Online ahead of print.ABSTRACTRecent advances in the development of sorbent materials have enabled the development of hemoperfusion (HP). However, HP dose and prescription are not standardized and there is no consensus in clinical practice guidelines. Adequate prescription and modality are of utmost importance to ensure HP effectiveness. Although the main indication of CytoSorb®, HA330/380, polymyxin B, and Seraph® is sepsis, these devices may be beneficial in many other situations such as liver failure, rhabdomyolysis, pancreatitis, cardiopulmonary bypass, ex...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Frank Bidar Stanislas Abrard Antoine Lamblin Thomas Rimmel é Source Type: research
Extracorporeal Techniques Based on Adsorption: Nomenclature, Hardware, and Circuit Design
Contrib Nephrol. 2023 Jun 1;200:1-8. doi: 10.1159/000529313. Online ahead of print.ABSTRACTSorbents have been utilized in the past for intoxication and poisoning, but their spectrum of clinical application is now expanding. Hemoadsorption (HA) is still indicated for toxin and poison removal, but other molecules are considered appropriate targets for this blood purification modality. HA combined with hemodialysis (HA + HD) has been proposed for end-stage kidney disease patients to remove molecules that are not easily removed by classic HD or hemodiafiltration. More recently, a rationale for the use of sorbents in critical i...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Rinaldo Bellomo Source Type: research
Oxiris Membrane in Sepsis and Multiple Organ Failure
Contrib Nephrol. 2023 Jun 1;200:1-11. doi: 10.1159/000527355. Online ahead of print.ABSTRACTSepsis and multiple organ failure (MOF) are characterized by multiple hemodynamic changes and imbalanced immune response of the patient. Oxiris is a highly adsorptive membrane with the ability to remove cytokines and endotoxins, as well as to perform renal replacement therapy. Here we describe the evolution from previous AN69 to the 3-in-1 Oxiris membrane, and review its characteristics and performance. In clinical practice, Oxiris showed consistent effects in mean arterial pressure recovery, a decrease in vasopressor needs, and red...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Matteo Cecchi Arnau Ulsamer Gianluca Villa Source Type: research
History and Development of Sorbents and Requirements for Sorbent Materials
Contrib Nephrol. 2023 Jun 1;200:1-6. doi: 10.1159/000529569. Online ahead of print.ABSTRACTThe history of sorbents is about 2 centuries long. It is important to analyze and report the progress of science in this field, understand how modern hemoadsorption takes place, and appreciate how new devices have been designed and manufactured. It is also important to describe the nature, the structure, and the composition of sorbent materials and characterize the mechanisms of the adsorption process. Progressive improvements have been obtained from the original aluminosilicates and porous carbons with the use of new synthetic polym...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Rinaldo Bellomo Source Type: research
Preface
Contrib Nephrol. 2023 Jun 1;200:1-2. doi: 10.1159/000530016. Online ahead of print.NO ABSTRACTPMID:37263195 | DOI:10.1159/000530016 (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Rinaldo Bellomo Source Type: research
Bilirubin Adsorption with DPMAS: Mechanism of Action and Efficacy of Anion Exchange Resin
Contrib Nephrol. 2023 Jun 1;200:1-9. doi: 10.1159/000526729. Online ahead of print.ABSTRACTAcute liver failure and acute-on-chronic liver failure are conditions in which the loss of metabolic function of the liver leads to the accumulation of several toxins such as bilirubin. Patients with sepsis or multiple organ dysfunction syndrome have a greater risk of developing liver failure, and hyperbilirubinemia is associated with poor prognosis. Bilirubin removal may not only alleviate signs and symptoms of liver dysfunction but also act as an index of removal of albumin-bound toxins. Conjugated and unconjugated bilirubin, due t...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Matteo Marcello Claudio Ronco Source Type: research
Clinical Applications of Adsorption: The New Era of Jafron Sorbents
Contrib Nephrol. 2023 Jun 1;200:1-7. doi: 10.1159/000529845. Online ahead of print.ABSTRACTThe Jafron series of sorbent cartridges provides a comprehensive array of coated, highly biocompatible sorbent beads made of styrene-divinylbenzene copolymers. Such beads carry a mean diameter of 0.8 mm with a range from 0.60 to 1.18 mm. The maximal pore size of these coated beads and the volume of the cartridge vary according to the type of cartridge ranging between 50 Da and 60 kDa. The sorbents, the size of the cartridge, the volume of sorbent, and the pore size (which reaches 60 kDa with the HA330 cartridge) aim to take advantage...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Rinaldo Bellomo Claudio Ronco Source Type: research
Combined Hemoperfusion-Hemodialysis in End-Stage Renal Disease Patients
Contrib Nephrol. 2023 Jun 1;200:1-5. doi: 10.1159/000527953. Online ahead of print.ABSTRACTDespite advances in dialysis technology, a high level of morbidity and mortality is still present in end-stage renal disease patients undergoing maintenance dialysis. This has been in great part correlated with accumulation of uremic toxins that cannot be adequately removed by classic dialysis membranes and techniques. Improvements have been made in enhancing both membrane permeability and convection rates as in the case for expanded hemodialysis (HD) and hemodiafiltration, but these techniques still present limitations or cannot be ...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Source Type: research
