Blood Purification

INTRODUCTION: Patients with end-stage renal disease (ESRD) are known to have reduced structural and functional brain connectivity in the brain regions associated with cognitive function. However, the effect of dialysis on brain connectivity remains unclear. This study aimed to evaluate the effects of dialysis on structural brain connectivity in patients with ESRD. METHODS: This prospective study included 20 patients with ESRD in the pre-dialysis stage and 35 healthy controls...

INTRODUCTION: The effect of change in sodium (Na) in critically ill patients undergoing slow low-efficiency dialysis (SLED) is unclear. METHODS: Prospective observational study enrolled dysnatremic critically ill adult patients with acute kidney injury (AKI) undergoing the first SLED as cases and normonatremic patients as controls. Baseline and SLED-related parameters, and 30-day mortality were noted. RESULTS: 100 dysnatremic and 51 normonatremic patients were included, with a median age of 31(25-52) years and median admission SOFA scores of 10 (9-12)...

INTRODUCTION: Hypotension is common during intermittent hemodialysis (IHD) and may be due to a decreased cardiac index (CI). However, no study has simultaneously and continuously measured CI and mean arterial pressure (MAP) to understand the prevalence, severity, and duration of CI decreases or relate them to MAP, blood volume (BV) and net ultrafiltration (NUF) rate. METHODS: In a prospective, pilot and feasibility investigation, we studied 10 chronic IHD patients...

BACKGROUND: Generative artificial intelligence (AI) is rapidly transforming various aspects of healthcare, including critical care nephrology. Large language models (LLMs), a key technology in generative AI, show promise in enhancing patient care, streamlining workflows, and advancing research in this field. SUMMARY: This review analyzes the current applications and future prospects of generative AI in critical care nephrology. Recent studies demonstrate the capabilities of LLMs in diagnostic accuracy, clinical reasoning, and continuous renal replacement therapy (CRRT) alarm troubleshooting...

INTRODUCTION: Chronic kidney disease (CKD) poses a significant global health burden, with increasing prevalence and high morbidity and mortality rates, particularly in end-stage kidney disease (ESKD). While traditional risk factors contribute, the exact mechanisms remain elusive, with inflammation playing a pivotal role. Medium cut-off (MCO) membranes offer promise in improving dialysis outcomes by efficiently clearing uremic toxins without substantial albumin loss. We aimed to elucidate the impact of MCO and high-flux (HF) membranes on peripheral blood lymphocyte subpopulations in hemodialysis patients...

INTRODUCTION: Chloride transfers during continuous renal replacement therapy (CRRT) have not been adequately described and may differ based on CRRT technique. We aimed to measure chloride mass transfer (JS,Cl) during CRRT and identify associated determinants. METHODS: We performed a two-center, prospective, observational study in France and Australia in ICU patients with CRRT initiated for < 24h. Patients received continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD, with citrate-CaCl2 regional anticoagulation)...

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INTRODUCTION: In this systematic review and meta-analysis, we aimed to review available data and provide pooled estimates of the predictive performance of urinary chemokine (CC motif) ligand (uCCL14') for persistent (≥48 hours) severe acute kidney injury (PS-AKI). METHODS: We searched MEDLINE, PubMed, Cochrane Library, and EMBASE for studies published up to April 11, 2023. We considered all studies including adults and reporting on the ability of uCCL14 to predict PS-AKI as defined by AKI persisting for 48 or 72 hours...

INTRODUCTION: Hematocrit monitoring during continuous renal replacement therapy (CRRT) allows the continuous estimation of relative blood volume (RBV). This may enable early detection of intravascular volume depletion prior to clinical sequelae. We aimed to investigate the feasibility of extended RBV monitoring and its epidemiology during usual CRRT management by clinicians unaware of RBV. Moreover, we studied the association between changes in RBV and net ultrafiltration (NUF) rates...

INTRODUCTION: Continuous Renal Replacement Therapy (CRRT) is a prolonged continuous extracorporeal blood purification therapy to replace impaired renal function. Typically, CRRT therapy requires routine anticoagulation, but for patients at risk of bleeding and with contraindications to sodium citrate, anticoagulant-free dialysis therapy is necessary. However, this approach increases the risk of CRRT circuit coagulation, leading to treatment interruption and increased resource consumption...

INTRODUCTION: Uremic patients exhibit remarkably increased rates of mortality and cardiovascular (CV) events, but risk prediction in this setting remains difficult. Systemic mitochondrial dysfunction is pervasive in end-stage kidney disease and may contribute to CV complications. We tested the clinical significance of circulating MOTS-c, a small mitochondrial-derived peptide, as a biomarker for improving mortality and CV risk prediction in hemodialysis (HD) patients. METHODS: We conducted a prospective, observational, multicenter study on 94 prevalent HD patients...

INTRODUCTION: Hemoadsorption, an extracorporeal apheresis technique, is reportedly used in severe COVID-19 patients. However, limited evidence from randomized clinical trials supports this practice. METHODS: In this single-center study, severe COVID-19 patients requiring ICU admission were randomly assigned (1:1) to receive HA-330 Hemoadsorption in combination with standard treatment or standard therapy alone. Both groups received tocilizumab intravenously if their clinical conditions worsened within 24 to 48 hours...

Introduction Exogenous haptoglobin administration may enhance plasma-free hemoglobin (pfHb) clearance during hemolysis, and reduce its end-organ damage: we sought to systematically review and summarize available evidence on the use of haptoglobin as a treatment for hemolysis of any cause. Methods We included studies describing haptoglobin administration as treatment or prevention of hemolysis-related complications. Only studies with a control group reporting at least one of the outcomes of interest were included in the quantitative synthesis...

INTRODUCTION: Autogenous arteriovenous fistula (AVF) is the preferred vascular access in patients undergoing maintenance hemodialysis (MHD). However, complications such as thrombosis may occur. This study aimed to construct and validate a machine learning-based risk-prediction model for AVF thrombosis, hypothesizing that such a model can effectively predict occurrences, providing a foundation for early clinical intervention. METHODS: The retrospective longitudinal study included a total of 270 patients who underwent MHD at the Hemodialysis Center of the Second Affiliated Hospital of Harbin Medical University between March 2021 and December 2022...

Enkephalins are involved in the regulation of renal function. Proenkephalin A, also known as PenKid, has been demonstrated to be a reliable biomarker for kidney function and its plasma concentration correlates with measured glomerular filtration rate. PenKid is used for prediction and diagnosis of AKI, and need of renal replacement therapy (RRT). PenKid has also been used to predict the successful weaning from RRT in patients with AKI. Whether the concentration of PenKid is affected or not by RRT, is a controversial point and there are no studies describing the kinetics of the molecule...

INTRODUCTION: Despite major advances in the field of dialysis, there are still some unmet needs such as reducing inflammation through adequate depuration. It is well known that the wide spectrum of pro-inflammatory and pro-atherosclerotic uremic toxins are inefficiently removed by current dialysis techniques. Adsorption seems to be an extra tool to remove toxins, but its effect and optimization have not been widely studied. The aim of this report was to present preliminary results regarding the possibility of performing hemodiafiltration with a highly adsorptive polymethylmethacrylate membrane...

AIM: To assess the association of age and frailty with clinical outcomes in patients with severe AKI, according to accelerated and standard renal-replacement therapy (RRT) initiation strategies in the STARRT-AKI trial. METHODS: This was a secondary analysis of an international randomized trial. Older age was defined as ≥65 years. Frailty was assessed using the clinical frailty scale (CFS) score and defined as a score ≥5. The primary outcome was all-cause mortality at 90 days...

INTRODUCTION: The main objective of this study was to evaluate the impact of hemoadsorption on the elimination of inflammatory mediators. METHODS: A prospective, bicenter, observational cohort study was conducted between March 2020 and February 2022 to explore the immunomodulatory response, demographic and clinical characteristics of individuals with COVID-19 admitted to the ICU with severe acute respiratory failure and in need of CRRT with Oxiris® with or without AKI...

No abstract text is available yet for this article.

INTRODUCTION: Anticoagulants are used in continuous renal replacement therapy (CRRT) to prolong filter life. There are no prior investigations directly comparing epoprostenol to more commonly used forms of anticoagulation in children. Therefore, the primary aim of this study was to assess the efficacy and safety of epoprostenol as compared to heparin and citrate anticoagulation in a pediatric cohort. METHODS: We performed a retrospective analysis of all patients <18 years of age admitted to an academic quaternary care children's hospital from 2017-2022 who received epoprostenol, heparin, or citrate exclusively for CRRT anticoagulation...