Hemoperfusion in Leptospirosis
Contrib Nephrol. 2023 Jun 1;200:1-10. doi: 10.1159/000527571. Online ahead of print.ABSTRACTLeptospirosis is the most common zoonosis frequently seen in the tropics and subtropics especially during the rainy season when humans wade in floods contaminated by the urine of infected rats in urban areas. Aside from direct toxicity of the leptospires, the role of an exuberant immune response to the pathogen leading to secondary organ damage has been recognized. Thus, our treatment protocol for patients with severe leptospirosis characterized by renal failure, acute liver injury, and lung hemorrhage now includes a short course of...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Romina A Danguilan Source Type: research
Hemoperfusion with CytoSorb ®: Current Knowledge on Patient Selection, Timing, and Dosing
Contrib Nephrol. 2023 Jun 1;200:1-8. doi: 10.1159/000527774. Online ahead of print.ABSTRACTDirect hemoperfusion with the CytoSorb® adsorbent has experienced widespread use in several critical care settings including sepsis and multiorgan failure. The reported conditions of clinical usage and resulting outcomes vary considerably. The aim of the study was to provide an overview on current treatment recommendations based on the available clinical evidence. We performed a literature analysis using PubMed/MEDLINE and ClinicalTrials.gov to identify clinical data describing parameters of clinical usage of CytoSorb® in patients ...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Gerd Klinkmann Sebastian Koball Daniel A Reuter Steffen Mitzner Source Type: research
Update on the Role of Polymethylmethacrylate Membrane Hemofilter in Acute and Chronic Renal Dysfunction
Contrib Nephrol. 2023 Jun 1;200:1-10. doi: 10.1159/000530476. Online ahead of print.ABSTRACTDespite recent technical advances in dialysis care over the past decades, the mortality rate of critically ill patients with acute kidney injury (AKI) requiring dialysis and of chronic kidney disease (CKD) remains unacceptably high. Several preclinical studies have increased our knowledge of the principal mechanisms involved in the pathophysiology of AKI and CKD. Additionally, the development of efficient and specific compensatory sorbent systems in renal replacement therapy to remove unwanted compounds has created the possibility t...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Alessandra Stasi Rossana Franzin Rosa Losapio Carlo Alfieri Loreto Gesualdo Giuseppe Castellano Source Type: research
Hemoperfusion and Immunomodulation
Contrib Nephrol. 2023 Jun 1;200:1-7. doi: 10.1159/000529885. Online ahead of print.ABSTRACTRecent development in sorbent technology has spurred new interest in the potential of hemoperfusion (HP) in clinical conditions such as cytokine release syndromes and sepsis. Although the role of nonselective HP in such conditions requires solid evidence and more studies, the rationale for clinical application is clearly emerging. Greater biocompatibility and safety of the new sorbents may allow easy and safe application of HP in those conditions where the innate and the adaptive immune response of the individual appears to be dysreg...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Sara Samoni Rinaldo Bellomo Source Type: research
Adsorption of Endotoxin and Mitigation of Sepsis
Contrib Nephrol. 2023 Jun 1;200:1-9. doi: 10.1159/000527708. Online ahead of print.ABSTRACTIn the fields of sepsis and systemic inflammation, endotoxin might be the most studied molecule since the term was coined by Richard Pfeiffer in 1892. Paradoxically measuring endotoxin in humans and finding an effective treatment for endotoxemia have remained challenging. While advances have been made in understanding the mechanisms of how this simple molecule can trigger an intense immune cascade, there is an ever growing need to develop better treatments. Studies measuring endotoxin levels in patients with septic shock have consist...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: John A Kellum Hisataka Shoji Debra M Foster Paul M Walker Source Type: research
Anticoagulation Prophylaxis in Extracorporeal Adsorption Techniques
Contrib Nephrol. 2023 Jun 1;200:1-6. doi: 10.1159/000527572. Online ahead of print.ABSTRACTIn this chapter, anticoagulation treatments for adsorption techniques in continuous renal replacement therapy (CKRT) will be reviewed. Anticoagulation used with adsorption techniques is quite different than anticoagulation in classical CKRT with nonadsorptive therapies. Regional citrate anticoagulation (RCA) and unfractionated heparin (UFH) are the most common anticoagulation modalities for both nonselective adsorptive membranes - such as surface-treated acrylonitrile 69 membranes (AN69ST) and polymethylmethacrylate membranes - and s...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Patrick M Honore Sydney Blackman Ibrahim Bousbiat Emily Perri ëns Rachid Attou Source Type: research
The Process of Adsorption and Cartridge Design
Contrib Nephrol. 2023 Jun 1;200:1-8. doi: 10.1159/000529295. Online ahead of print.ABSTRACTThe mechanism of adsorption is regulated by various factors including the nature of the sorbent and the molecules involved in the adsorption process. The design of a device for adsorption therapies must fulfil specific requirements. The device should allow the use of the minimum amount of sorbent material sufficient to achieve safe and effective blood purification therapy. Each component of the device must respond to criteria of safety and function in order to maximize the efficiency of the cartridge. The design should be optimized t...
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Rinaldo Bellomo Source Type: research
Introduction
Contrib Nephrol. 2023 Jun 1;200:1. doi: 10.1159/000530015. Online ahead of print.NO ABSTRACTPMID:37263241 | DOI:10.1159/000530015 (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - June 1, 2023 Category: Urology & Nephrology Authors: Claudio Ronco Source Type: research
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
