Blood Purification Technology Research Articles

Psychological Intervention for Depression and Anxiety in Hemodialysis Patients: A Meta-Analysis.

With the advancement of blood purification technology, there is increasing attention to the mental health of hemodialysis patients, particularly concerning depression. This study aims to determine the effect of psychological interventions on anxiety and depression in hemodialysis patients through a meta-analysis. A computerized search was conducted to identify randomized controlled trial (RCT) studies published in PubMed, Embase, Web of Science, ScienceDirect, and Cochrane Library databases from their inception to October 2023, focusing on the effects of psychological interventions on improving depression in hemodialysis patients. Data extraction, quality evaluation, and cross-checking were performed independently by two researchers. The methodological quality of the included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews and the meta-analysis was performed using RevMan 5.4 software (The Nordic Cochrane Centre, Copenhagen, Denmark). The effect of psychological interventions on anxiety and depression in hemodialysis patients was determined by combining effect sizes and I2 statistics. Fifteen studies were included, encompassing a total of 929 hemodialysis patients: 468 in the intervention group and 461 in the control group. The results indicated that psychological interventions could improve depressive moods [mean difference (MD) = -4.91, 95% confidence intervals (CI) (-6.56, -3.26), p < 0.001] and anxiety status [MD = -5.11, 95% CI (-6.97, -3.25), p < 0.001]. A subgroup analysis based on the intervention duration (more or less than 8 weeks) revealed that patients experienced significant improvements in depression and anxiety regardless of the intervention length. Additionally, subgroup analyses focusing on quality of life demonstrated that psychological interventions significantly improved the psychological aspects of patients' quality of life [MD = 7.31, 95% CI (1.06, 13.56), p = 0.001]. Sensitivity analysis, which excluded sources of heterogeneity, indicated that psychological interventions significantly enhanced both the psychological [odds ratios (OR) = 4.14, 95% CI (1.08, 7.20), p = 0.008] and physical [MD = 2.52, 95% CI (0.10, 4.95), p = 0.04] aspects of patients' quality of life. Psychological interventions can significantly alleviate depression and anxiety in hemodialysis patients and improve their quality of life. Psychotherapy holds promise as an effective method for improving depression in dialysis patients.

The safety and efficacy of regional citrate anticoagulation for multiple consecutive therapeutic plasma exchanges with fresh frozen plasma as a replacement solution.

Therapeutic plasma exchange (TPE) is an important blood purification technology and most patients require multiple consecutive TPEs. Regional citrate anticoagulation (RCA) could be used for membrane therapeutic plasma exchange (mTPE). However, there is no research on the metabolic complications of the RCA for patients receiving multiple consecutive mTPEs with fresh frozen plasma (FFP) as a replacement solution. We retrospectively included patients who used RCA for multiple consecutive mTPEs with FFP as a replacement solution in Xijing Hospital from 2020 to 2022. We collected blood gas analysis and electrolyte results before and after mTPE treatment and analysed the anticoagulation effectiveness and metabolic complications of the RCA. A total of 33 patients who underwent 131 mTPE sessions were included, and 129 (98.5%) sessions were successfully completed. Severe hypocalcemia (19.1%) and metabolic alkalosis (58.5%) were frequently observed. In single mTPE sessions, there was a significant decrease in ionized calcium levels and significant increases in serum sodium, potassium, pH, bicarbonate, and base excess (BE) levels compared to pretreatment values. When comparing the values after the last treatment to the baseline values in all 33 patients, the serum sodium, pH, bicarbonate, and BE levels increased significantly, while the ionized calcium decreased significantly. The levels of pH, bicarbonate, and BE increased with the number of mTPE sessions, and the cumulative incidence of metabolic alkalosis reached 95.2% after the fifth treatment according to the Kaplan-Meier survival analysis. RCA is an effective anticoagulation method for patients undergoing mTPE with FFP as a replacement solution. However, the metabolic complications associated with RCA, especially hypocalcemia and metabolic alkalosis, frequently develop in patients who undergo multiple consecutive mTPEs with FFP.

Clinical application of blood purification in polymyositis/dermatomyositis.

We investigated the clinical efficacy and safety of blood purification technology in patients with polymyositis/dermatomyositis. In a study of 22 patients, 10 cases received blood purification treatment (5 cases received plasma exchange, 5 cases received plasma HA280 immunoadsorption), and 12 cases served as the control group. A 3-month follow-up was conducted to compare the clinical manifestations and laboratory examination. Symptoms and signs of patients in treatment group were significantly improved, and the hormone usage was lower than the control group. For patients with normal creatine kinase level and ferritin level below three times the upper limit of normal, there was a positive correlation between their N/L values and MDAAT scores. The results of this study suggest that blood purification therapy, including plasma HA280 immunoadsorption and plasma exchange, is an effective and safe treatment for patients with polymyositis/dermatomyositis, offering assistance in reducing hormone usage in the long-term.

Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis.

We aimed to investigate the clinical efficacy of blood purification technology based on cytokine adsorption in the treatment of sepsis. Sixty patients with sepsis were randomly divided into control (n = 30) and experimental (n = 30) groups. Both groups were given routine treatment and continuous venovenous hemofiltration, and on this basis, the experimental group received acrylonitrile/sodium methacrylate (AN69ST) blood purification. The levels of C-reactive protein, procalcitonin, white blood cell count, albumin, platelets, total bilirubin, creatinine, lactic acid, and APACE II score, as well as secretion of inflammatory factors interleukin (IL)-6 and tumor necrosis factor (TNF-α) were compared. The hospitalization time, mechanical ventilation (MV) time, drug use time, and mortality were analyzed. After treatment, the secretion levels of IL-6 and TNF-α were decreased, and other indicators were significantly improved compared with those before treatment (P < 0.05), especially in the experimental group (P < 0.05). The hospitalization time, MV time, and drug use time in the experimental group were significantly lower than those of the control group (P < 0.05), and the mortality was lower than that in the control group (P < 0.05). In conclusion, blood purification technology based on cytokine adsorption can significantly improve various indicators of sepsis patients, reduce hospitalization time, reduce mortality, and improve the prognosis.

Application of blood purification based on a new type of nanofiber membrane in critically ill patients and comparative analysis of its nursing methods

Blood purification technology is one of the main treatment methods to prolong the life of severe patients. The traditional blood purification membrane materials have the disadvantages of non-selective adsorption, single pore size and low permeability, and need to develop new and efficient blood purification membrane materials. To explore the application of a new type of nanofiber membrane in blood purification of critically ill patients and compare and analyze its nursing methods. When the experimental subjects are performing blood purification, a new nanofiber membrane material is used in the purification machine. The control group adopted conventional nursing methods, while the experimental group adopted targeted nursing methods based on the nursing methods of the control group. After intervention, the eight indicators of quality of life in the experimental group were significantly improved (P < 0.05), for example, the score of physiological function was increased from 41.042 ± 7.625 to 54.236 ± 2.544, and the energy status was increased from 46.094 ± 7.192 to 59.768 ± 4.241. The physiological and biochemical indexes of both groups tend to be normal, but the experimental group is more obvious. The patients in the experimental group were more satisfied with the nursing services provided in the process. The new blood purification method of nanofiber membrane can overcome the shortcomings of traditional purification and remove toxic small and medium-sized molecules to the maximum extent.

Application of blood purification technology in severe fever with thrombocytopenia syndrome

ABSTRACT Objective: The purpose of this paper is to summarize the blood purification technology applied in patients with severe fever with thrombocytopenia syndrome (SFTS) in the clinical treatment effect. Methods: The medical records of 96 patients with severe SFTS admitted to Weihai Municipal Hospital affiliated to Shandong University from May 2014 to November 2019 were retrospectively analyzed, and they were divided into survival group and death group. The differences in basic data test indexes and treatment method selection during intensive care unit (ICU) admission between the two groups were significantly analyzed, and the indexes with statistically significant differences were included in the multivariate logistic regression analysis related to prognosis. Results: There were no statistically significant differences in age, sex composition, white blood cell count, platelet count, creatine kinase (CK), activated partial thromboplastin time (APTT), serum creatinine and hemofiltration renal replacement therapy between the survival group and the death group. There were statistically significant differences between the two groups in viral load bilirubin and the treatment methods of plasma exchange (PE) or hemoperfusion (HP). Plasma exchange group (78 cases), hemofiltration group (12 cases), hemoperfusion group (6 cases), plasma exchange and hemoperfusion and other blood purification treatment of the prognosis were statistically different. Conclusions: Compared with the three blood purification methods, plasmapheresis has a significant effect on virus removal, improvement of coagulation function and survival rate in patients with severe SFTS. Hemofiltration plays a role in removing inflammatory mediators, replacing renal function, maintaining electrolytes and acid-base balance, but not in removing viruses.

Clinical Efficacy of Blood Purification in the Treatment of Sepsis: a Meta-Analysis of the last 5 Years.

Sepsis is the second leading cause of death in the intensive care unit (ICU) after coronary heart disease. Blood purification (BP) technology is a protocol for treating sepsis patients, but efficacy is controversial. Herein, we did a meta-analysis of the last 5 years of studies to investigate the clinical efficacy of blood purification in the treatment of sepsis. We searched for studies of BP treatment of sepsis patients on PubMed, Embase, Medline, and Cochrane library. Two independent reviewers assessed included studies and met to develop consensus on included studies. We also used Review Manager 5.3 software to evaluate the risk of bias. The present meta-analysis included 13 randomized controlled trials (RCT) containing 1,230 sepsis patients. In the fixed-effect meta-analysis of 13 RCTs, BP treatment had a statistically significant efficacy on mortality (OR = 0.76, 95% CI = 0.6 - 0.97, p = 0.03) and ICU stay time (SMD = -3.42, 95% CI = -5.30 to -1.54, p < 0.001) reduction for patients with sepsis. Further subgroup analysis showed that none of high-volume hemofiltration (OR = 0.69, 95% CI = 0.42 - 1.12, p = 0.13), polymyxin B blood perfusion (OR = 0.92, 95% CI = 0.64 - 1.30, p = 0.62), and cytokine adsorption (OR = 0.66, 95% CI = 0.37 - 1.17, p = 0.15) significantly reduced mortality in sepsis patients. Adjuvant blood purification therapy can reduce mortality and shorten ICU stay for patients with sepsis, but the clinical efficacy of different blood purification techniques is inconsistent.

Removal of Circulating Tumor Cells from Blood Samples of Cancer Patients Using Highly Magnetic Nanoparticles: A Translational Research Project.

The count of circulating tumor cells (CTCs) has been associated with a worse prognosis in different types of cancer. Perioperatively, CTCs detach due to mechanical forces. Diagnostic tools exist to detect and isolate CTCs, but no therapeutic technique is currently available to remove CTCs in vivo from unprocessed blood. The aim of this study was to design and test new magnetic nanoparticles to purify whole blood from CTCs. Novel magnetic carbon-coated cobalt (C/Co) nanoparticles conjugated with anti-epithelial cell adhesion molecule (EpCAM) antibodies were synthesized, and their antifouling and separation properties were determined. The newly developed C/Co nanoparticles showed excellent separation and antifouling properties. They efficiently removed tumor cells that were added to healthy subjects’ blood samples, through an anti-EpCAM antibody interaction. The nanoparticles did not interact with other blood components, such as lymphocytes or the coagulation system. In blood samples of carcinoma patients suffering from metastatic disease, on average, ≥68% of CTCs were removed. These nanoparticles could prompt the development of a blood purification technology, such as a dialysis-like device, to perioperatively remove CTCs from the blood of cancer patients in vivo and potentially improve their prognosis.

Serum Cystatin C Level Monitoring for Intervention Opportunity of CBP in Children with Severe Sepsis.

Objective The aim of this study is to investigate the instruction value of the serum cystatin C (Cys C) level monitoring for intervention opportunity of continuous blood purification technology (CBP) in children with severe sepsis. Methods 67 children with severe sepsis in the pediatric intensive care unit (PICU) with CBP treatment were retrospectively selected from May 2016 to April 2020. According to the time intervals between the time point of serum Cys C level began to increase (>15 mg/L) and the time point of CBP began, all children were divided into group A (<24 h, 29 cases), group B (24–48 h, 22 cases), and group C (>48 h, 16 cases). The children's general characteristics, vital signs, biochemical parameters, acute physiology and chronic health evaluation (APACHE II), and sequential organ failure assessment (SOFA) scores were evaluated. The influence factors of prognosis of children with severe sepsis were analyzed by multivariate regression analysis. Results The intervals between the time point of PICU hospitalization and the time point of CBP began and the times of CBP in group A were significantly more than those in group B and C (P < 0.05). There was no statistically significant duration of CBP among three groups (P > 0.05). After follow-up of 28 d, there was no significant difference on the occurrence of coagulation disorders and hypovolemic shock induced by CBP among three groups (P > 0.05). However, the mortality of children in group A was lower than that in group C (P < 0.05). Children in group A had lower APACHE II scores, SOFA scores, serum K+, blood urea nitrogen (BUN), serum creatine (SCr), partial pressure of carbon dioxide (PCO2), and higher partial pressure of oxygen (PO2) than those of children in group C after CBP. (P < 0.05). SOFA scores ≥5 after CBP treatment and the time intervals between the time point of serum Cys C level began to increase (>15 mg/L) and the time point of CBP began ≥24 h were the independent influence factors on the prognosis by multivariate regression analysis. Conclusion There are significant evidences that continuous blood purification technology within 24 h of serum Cys C level may better control the condition of children with severe sepsis.

Clinical Features of Severe Tsutsugamushi Disease Complicated with Hemophagocytic Lymphohistiocytosis

The article discusses a case of severe tsutsugamushi disease complicated with hemophagocytic syndrome in Guangdong Maternal and Child Health Hospital and concludes that blood purification technology has significant therapeutic effect among children with severe HLH complicated with multiple organ dysfunction.

POS-608 CLINICAL OUTCOMES OF HEMOPERFUSION USING HA130 CARTRIDGE AMONG MAINTENANCE HEMODIALYSIS PATIENTS IN ST. LUKE’S MEDICAL CENTER-QC AND GAT ANDRES MEMORIAL MEDICAL CENTER: A CROSS-SECTIONAL STUDY

Despite the advancement in blood purification technology, the mortality rate of maintenance hemodialysis patients is still high with cardiovascular disease as the leading cause of death. This study aimed to compare the clinical outcomes of patients who underwent hemoperfusion using HA-130 cartridge with hemodialysis to those with hemodialysis alone among maintenance hemodialysis patients in St. Luke’s Medical Center Quezon City dialysis unit and Flora V Valisno De Siojo Dialysis Center of Gat Andres Bonifacio Memorial Medical Center from August 2018–May 2019. This cross-sectional study included 183 patients who underwent hemodialysis (HD) and hemoperfusion HP) using HA-130 cartridge and 156 patients on hemodialysis alone. Serum phosphorous, albumin, hemoglobin, erythropoietin(EPO) dose, Kt/V, hospitalizations, and mortality were compared from baseline, at the start and end of hemoperfusion when appropriate and between these two groups. Significant differences in baseline characteristics were: the patients in HD alone group were older (p = 0.002), predominantly had diabetic kidney disease (p = 0.002), and hemoglobin of <9.5 g/dl (p = 0.0001). While most patients in HD + HP group had hypertensive nephrosclerosis (p = 0.003), with hemoglobin 9.5 to 11.5 g/dl (p = 0.001) and >11.5 g/dl (p = 0.038). Main indication for hemoperfusion was an elevated serum phosphorous which was increased in HD + HP group (p = 0.0001). From baseline values, these variables improved after hemoperfusion: EPO dose (mean = 9448 + 3626.4 versus 10092 + 3405.6 units/week, p = 0.050, 95%CI -1286.4 to 0.95); hemoglobin (mean = 10.8 + 1.5 versus 10.5 + 1.7g/dl, p = 0.016, 95%CI 0.1 to 0.7); and albumin (mean = 3.9 + 0.5 versus 3.7 + 0.6 g/dl, p = 0.010, 95%CI 0.03 to 0.2). There was no significant difference with phosphorous (mean = 2.04 + 0.7 versus 2.08 + 0.6 mmol/L, p = 0.520, 95%CI -0.2 to 0.1) at the end of the study, although there was a significant difference in the second and third months of treatment (p = 0.0001). At the end of the study; albumin (p = 0.0001, 95%CI -0.4 to -0.03) and hemoglobin (p = 0.0004, 95%CI -1.0 to -0.3) were significantly higher in HD+HP group. The percentage of patients with hemoglobin <9.5 g/dl was significantly lower(p = 0.0001) in HD+HP group (10.9%) than in HD alone group (34.2%). Although the phosphorous in HD alone group was lower (p = 0.017, 95%CI -0.4 to -0.03) than in HD + HP group, it increased in HD alone group from baseline (mean = 1.84 + 0.70 versus 1.56 + 0.66mmol/L). There was no significant difference in EPO dose (p = NS) and Kt/V (p = NS) in both groups. Hospitalization rate OR = 4.23 (p = 0.0104, 95%CI 1.93 to 9.27) and mortality rate OR = 4.07 (p = 0.0001, 95%CI 1.30 to12.75) such that patients in HD alone group were four times more likely to be hospitalized and to die than those in HD+HP group Patients who underwent hemodialysis and hemoperfusion using HA-130 cartridge had a lower risk of hospitalization and mortality than those on hemodialysis alone. There were significant improvements in hemoglobin, erythropoietin dose, albumin, and phosphorous values from baseline in HD + HP patients.

Blood purification for sepsis: an overview.

Sepsis is a life-threatening organ failure exacerbated by a maladaptive infection response from the host, and is one of the major causes of mortality in the intensive care unit. In recent decades, several extracorporeal blood purification techniques have been developed to manage sepsis by acting on both the infectious agents themselves and the host immune response. This research aims to summarize recent progress on extracorporeal blood purification technologies applied for sepsis, discuss unanswered questions on renal replacement therapy for septic patients, and present a decision-making strategy for practitioners.

Blood Purification Technology in the Treatment of Type Ia Glycogen Storage Disease Complicated with Severe Lactic Acidosis: A Case Report and Literature Review

Glycogen storage disease type Ia is a genetic disease caused by glucose-6-phosphatase deficiency, which often causes hypoglycemia, hyperuricemia, hypertriglyceridemia, and lactic acidemia. Severe lactic acidosis is a serious complication of glycogen storage disease type Ia. This study aimed to analyze the clinical features and treatment of glycogen storage disease type Ia with severe lactic acidosis. We performed a retrospective analysis of the diagnosis and treatment of a patient with glycogen storage disease type Ia with severe lactic acidosis admitted to our department during the COVID-19 period and reviewed the related literature. The patient was admitted to our hospital for chest pain and vomiting of three days duration, which was accompanied by dyspnea for five hours. The patient has had a type Ia glycogen storage disease for 11 years, and arterial blood gas analysis revealed a pH of 7.192 and lactic acid levels of 26.77 mmol/L. However, the patient was diagnosed with type Ia glycogen storage disease alongside severe lactic acidosis. After 4 hours of hemodialysis and 36 hours of continuous blood purification, the patient had no shortness of breath, dyspnea, nausea, or vomiting. Biochemical retesting indicated a pH of 7.482, lactic acid levels of 7.41 mmol/L, and blood glucose levels of 10.7 mmol/L. Glycogen storage disease type Ia can lead to life-threatening severe lactic acidosis. Continuous renal replacement therapy is an effective treatment for severe lactic acidosis. Therefore, as prevention and control are being carried out during the COVID-19 period, attention should be given to the treatment of special populations, such as those with glycogen storage disease to prevent serious complications.

The Emergency Use of the oXiris Device with Continuous Kidney Replacement Therapy in COVID-19 Patients with Acute Kidney Injury

Throughout the pandemic, presentations of the Coronavirus disease-2019 (COVID-19) infection have varied. Upon entering the body, SARS-CoV-2 causes a rapid release of pro-inflammatory cytokines and endotoxins, leading to multi-organ failure in intensive care unit (ICU) patients. In our case report, we present a 51-year-old male with severe COVID-19 infection in the ICU needing mechanical ventilation. He developed oliguric acute kidney injury (AKI) with acute respiratory distress syndrome and fluid overload >20% and was started on high flow continuous venovenous hemodiafiltration with oXiris filter via Prismaflex® (HF-CVVHDF). The patient received oXiris filter-based HF-CVVHDF for 72 hours and was switched to conventional CVVHDF. The patient gradually recovered with supportive care and was discharged. Through this case, we wish to highlight the significance of the use of an extracorporeal blood purification technology in COVID-19 with an oXiris filter to prevent morbidity and mortality among severe COVID-19 patients admitted to the ICU with AKI.

Effect of High Flux Hemodialysis versus Hemodiafiltration on Metabolic Status in Hemodialysis Patients

Background: Hemodiafiltration (HDF) is a newly developed renal replacement therapy blood purification technology with more advantageous effects on hemodynamic stability and better removal of B2 microglobulin and phosphorous Objective: The aim of this study is to compare effect of high flux (HF), low flux (LF) dialysis membranes and hemodiafiltration (HDF) on the metabolic status in hemodialysis patients and quality of life of those patients. Patients and Methods: This study included 60 patients more than18 years old, clinically stable with end stage renal disease on regular HD for at least three years (3 yrs), selected from HD unit in (Kobry El Kobba Military Nephrology Hospital) in the period from March 2018 to September 2018. The patients were divided into three groups equally. Group I: 20 patients on low flux dialyzer, Group II: 20 patients on high flux dialyzer, Group III: 20 patients on hemodiafiltration. Results: There was a highly significant decrease in iPTH, B2 microglobulin and Phosphorous in patients received HDF (363.80±149.04, 8.79±7.22 and 4.31±0.74 respectively in comparison with patients received HF hemodialysis (540.10±242.55, 20.47±3.97and 4.58±1.07 respectively) and patients received LF hemodialysis (725.95±270.01, 36.60±7.22 and 5.73±1.34 respectively).Also, there were a highly significant increase in urea reduction ratio in HDF group compared to HF and LF groups (80.43±7.46, 76.03±9.55 and 65.81±7.42 respectively. Conclusion: Hemodiafiltration is the most effective dialysis technique than high flux and low flux dialysis membrane in removal of medium sized molecule and improvement of quality of life.

Hemoadsorption for blood purification-incomparability of clinically available procedures

HintergrundIm Bereich der Intensivmedizin, aber auch verstärkt in der Herzchirurgie, gewinnt der Einsatz von adsorptiven Blutreinigungstechnologien zur Behandlung von hyperinflammatorischen Zuständen an Bedeutung. Neben dem CytoSorb-Verfahren, das zunehmend klinisch akzeptiert und auch aktuell am häufigsten eingesetzt wird, drängen seit Kurzem weitere Firmen – vor allem aus China – mit ähnlichen Konzepten auf den Markt.Ziel der ArbeitVor diesem Hintergrund soll es Ziel dieses Artikels sein, exemplarisch auf unterschiedliche Aspekte zwischen den am Markt angebotenen Hämoadsorptionsprodukten einzugehen und einen kritischen Blick auf die vorhandene Evidenz zu werfen.MethodenAnalysiert wurden technische Merkmale, applikationsspezifische Besonderheiten und vorhandene Evidenz der Adsorptionstechnologien CytoSorb® (CytoSorbentsTM Inc., Monmouth Junction, NJ, USA), Jafron® HA-Serie (Jafron Biomedical Co., Guangdong, China) sowie der Biosky® MG-Serie (Biosun® Medical Technology Co., Foshan City, Guangdong Province, China). Nicht einbezogen wurden rein substanzspezifische Verfahren zur Endotoxinelimination (Toraymyxin®, Alteco®).ErgebnisseBei umfassender Analyse dieser Kriterien zeigt sich, dass zwischen den verfügbaren Technologien erhebliche Unterschiede hinsichtlich verwendeter Materialien, Adsorptionscharakteristika, Anwendung und verfügbarer Daten zu Sicherheit und klinischer Erfahrungen bestehen. Darüber hinaus wird deutlich, dass bei Blutreinigungstechnologien nicht nur deren Wirksamkeit unter Berücksichtigung eines Effekt-Preis-Leistungs-Verhältnisses betrachtet werden sollte, sondern insbesondere auch die klinische Sicherheit der einzelnen Verfahren von entscheidender Bedeutung ist.DiskussionUnter den analysierten Technologien stellt unserer Ansicht nach derzeit CytoSorb das am besten untersuchte und klinisch am weitesten etablierte Verfahren dar. Darüber hinaus ist darauf hinzuweisen, dass klinische Ergebnisse, insbesondere jedoch auch sicherheitsrelevante Aspekte, aufgrund der technisch unterschiedlichen Verfahren nicht zwischen den Produkten übertragbar sind.

Expanded hemodialysis: new opportunities and hopes

In the field of hemodialysis technologies, as in other fields of medicine, evolutionary changes are constantly taking place. The innovations are driven by unachieved clinical outcomes and desire to improve the quality of care of patients with CKD 5D. Recent advances in dialysis techniques resulted in the possibility to expand the permeability of dialysis membranes for a wider spectrum of uremic toxins that lead to the enhancement of long-term outcomes improving quality of life and reducing the mortality rate of dialysis patients. The inadequacy of existent dialysis techniques, at least in part, is due to the chronic accumulation of organic retention solutes of middle and large molecules, which are poorly or even not removed during dialysis.&#x0D; A gradual improvement in the elimination of uremic toxins is observed as a result of the development of new alternative approaches of hemodialysis therapy, such as high-flux hemodialysis, hemodiafiltration, expanded hemodialysis (HDx). However, some techniques have had limited success due to a host number of organizational, technological, financial and human factors. Expanded hemodialysis offers a novel blood purification technology in removal of the large spectrum of uremic toxins, in particular large medium molecules, due to the new structure of the dialysis membrane. There are a number of studies that prove the potential benefits of a new method of dialysis therapy over the previous ones, suggesting a reduction in cardiovascular mortality, vascular calcification and inflammation. In addition, there is evidence of a positive effect of HDx on the quality of life in dialysis patients. In particular, to minimize the manifestations of skin itching, restless legs syndrome, asthenic syndrome.

Multipoint dilution hemofiltration: A new technology for maximum convective clearance.

Convection-based renal replacement therapies (RRTs) have the potential to improve patient outcomes when compared to diffusion-based RRT such as hemodialysis (HD), but have limited clearance rates. We propose and characterize multipoint dilution hemofiltration (MPD-HF), a purely convective blood purification technology which removes the fundamental filtration limit associated with convective RRT resulting in clearance rates on par with HD. In MPD-HF, filtration of liquid and solutes occurs along the length of the hollow fibers that convey the blood, and substitution fluid is pushed into the fibers at multiple points along their length. Since multiple filtration and dilution steps are contained within one pass of the blood through the hollow fiber, the fraction of fluid that can be filtered may be increased to allow a high clearance rate that removes a wide range of toxins. In vitro tests yielded an average steady-state filtrate fraction of 68%, exceeding commercial HDF cartridge filtrate fractions by a factor of approximately 3. The molecular weights of molecules cleared spans up to the cutoff of 66 kDa for albumin.

Fabrication of low-fouling, high-loading polymeric surfaces through pH-controlled RAFT.

Low-fouling and high-loading surfaces are increasingly important for biosensing and blood purification technologies. Selective and efficient target binding from complex media can be achieved with poly(carboxybetaine) (pCB) surfaces that consist of a dense brush layer to resist non-specific protein adsorption and a sparse “mushroom” upper layer for high-density capture agent immobilization (i.e. high-loading). We developed pH-controlled surface-reversible addition–fragmentation chain-transfer (S-RAFT) polymerization to simplify fabrication of multi-modal, low-fouling and high-loading pCB surfaces without the need for quenching or re-initiation steps, toxic transition metals or light irradiation. Multi-modal polymer layers were produced through partial polymer termination by temporarily raising the pH to aminolyse a fraction of dormant chain transfer agents (CTAs); remaining polymer chains with intact CTAs continued uninterrupted extension to create the “mushroom” upper layer. The multi-modal pCB surfaces were low-fouling towards proteins (<6.7 ng cm−2), and macrophages. Compared to mono-modal brush surfaces, multi-modal pCB surfaces were high-loading with 5-fold greater capture agent immobilization (e.g. antibody) and 4-fold greater target binding (e.g. biotin-fluorescein).

Ticagrelor Removal by CytoSorb® in Patients Requiring Emergent or Urgent Cardiac Surgery: A UK-Based Cost-Utility Analysis.

BackgroundAcute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery.ObjectiveThe aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK.MethodsA de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters.ResultsIn emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit.ConclusionsThe implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.Electronic supplementary materialThe online version of this article (10.1007/s41669-019-00183-w) contains supplementary material, which is available to authorized users.