Review
Hematology
Jean Maxime Cote, Louis Pinard, Jean-Francois Cailhier, Renee Levesque, Patrick T. Murray, William Beaubien-Souligny
Summary: This meta-analysis found that there was no significant difference in short-term mortality and renal recovery in patients with severe AKI treated with intermittent HF or HDF compared to conventional HD. The overall quality of included studies was low, emphasizing the need for further evaluation of optimal convective parameters in AKI patients undergoing intermittent dialysis.
BLOOD PURIFICATION
(2022)
Article
Biochemistry & Molecular Biology
Ariane Duval-Sabatier, Stephane Burtey, Marion Pelletier, Manon Laforet, Laetitia Dou, Marion Sallee, Anne-Marie Lorec, Hafssa Knidiri, Floriane Darbon, Yvon Berland, Philippe Brunet
Summary: Hemodialysis can reduce uremic toxins, and hemodiafiltration improves the removal of middle molecules. However, it has no effect on indoles concentration, and different treatment methods do not significantly differ in the removal of protein-bound solutes.
Article
Medicine, General & Internal
Peter J. Blankestijn, Robin W. M. Vernooij, Carinna Hockham, Giovanni F. M. Strippoli, Bernard Canaud, Joergen Hegbrant, Claudia Barth, Adrian Covic, Krister Cromm, Andrea Cucui, Andrew Davenport, Matthias Rose, Marietta Torok, Mark Woodward, Michiel L. Bots
Summary: This study suggests that high-dose hemodiafiltration is more beneficial for patients with kidney failure compared to standard hemodialysis. A randomized controlled trial involving 1360 patients showed that those who received high-dose hemodiafiltration had a lower risk of death.
NEW ENGLAND JOURNAL OF MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Nicole M. Bohm, Chase Brown
Summary: During transitions between different dialysis modalities, careful dose adjustments and monitoring of medications with a narrow therapeutic index that are cleared in dialysis are crucial to avoid potential under- or over-dosing. In cases where patients switch from continuous to prolonged intermittent renal replacement therapy while receiving bivalirudin, preemptive dose adjustments may not be necessary, but clinicians should be aware of the possibility of rebound effects after cessation of dialysis.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Article
Critical Care Medicine
Edward G. Clark, Anitha Vijayan
Summary: Prolonged Intermittent Renal Replacement Therapy (PIRRT) refers to 'hybrid' forms of renal replacement therapy, which can be performed using an intermittent hemodialysis machine or a continuous renal replacement therapy (CRRT) machine. PIRRT treatments are longer in duration than typical intermittent hemodialysis treatments (6-12 h vs. 3-4 h, respectively), but not as continuous as CRRT (24 h per day). Usually, PIRRT treatments are provided 4 to 7 times per week. PIRRT is cost-effective and flexible, making it a safe choice for providing renal replacement therapy for critically ill patients. This article provides a brief review on the use and prescription of PIRRT in the ICU setting.
Article
Immunology
Georgios Lioulios, Asimina Fylaktou, Aliki Xochelli, Erasmia Sampani, Ioannis Tsouchnikas, Panagiotis Giamalis, Dimitra-Vasilia Daikidou, Vasiliki Nikolaidou, Aikaterini Papagianni, Ioannis Theodorou, Maria Stangou
Summary: End stage renal disease (ESRD) has detrimental effects on the immune system, leading to quantitative alterations of lymphocyte subpopulations. Using principal component analysis (PCA) and uniform manifold approximation and projection (UMAP), we found that ESRD patients have a more senescent immune phenotype, and dialysis prescription may play a role in determining the immunological groups within the patient cohort.
FRONTIERS IN IMMUNOLOGY
(2022)
Review
Physiology
Barbora Agatha Halouzkova, Jan Miroslav Hartinger, Vojtech Kratky, Vladimir Tesar, Ondrej Slanar
Summary: It is challenging to dose aminoglycosides in patients with kidney disease due to their prolonged half-life, and dialysis significantly affects drug concentrations. Therefore, dosing adjustments based on the changes in distribution and clearance phases in patients with abnormal renal functions, as well as considering the impact of hemodialysis on drug levels, are crucial for optimizing therapy.
KIDNEY & BLOOD PRESSURE RESEARCH
(2022)
Article
Engineering, Biomedical
Konrad Mendrala, Sylweriusz Kosinski, Pawel Podsiadlo, Mathieu Pasquier, Piotr Mazur, Peter Paal, Dariusz Gajniak, Tomasz Darocha
Summary: This study utilized a CVVHDF system in a laboratory setting to rewarm hypothermic patients, finding that rewarming rates increased with higher blood flow rates.
Article
Urology & Nephrology
Erin Chung, James A. Tjon, Rosaleen M. Nemec, Nadya Nalli, Elizabeth A. Harvey, Christoph Licht, Winnie Seto
Summary: This study characterized the pharmacokinetics of vancomycin in pediatric patients undergoing hemodialysis or hemodiafiltration, and found that duration of dialysis session and mode of dialysis were significant predictors of vancomycin pharmacokinetic parameters. The optimal dosing strategy for achieving target vancomycin concentrations was identified to guide clinical practice.
KIDNEY INTERNATIONAL REPORTS
(2021)
Article
Critical Care Medicine
William Beaubien-Souligny, Yifan Yang, Karen E. A. Burns, Jan O. Friedrich, Alejandro Meraz-Munoz, Edward G. Clark, Neill K. Adhikari, Sean M. Bagshaw, Ron Wald
Summary: In this study, 231 CRRT-to-IRRT transitions were evaluated in 213 critically ill patients with AKI, with 50.2% experiencing IDH during the first IRRT session. Factors associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. The occurrence of IDH events during CRRT-to-IRRT transition was found to be independently associated with hospital mortality.
ANNALS OF INTENSIVE CARE
(2021)
Article
Critical Care Medicine
Stephane Gaudry, Francois Grolleau, Saber Barbar, Laurent Martin-Lefevre, Bertrand Pons, Eric Boulet, Alexandre Boyer, Guillaume Chevrel, Florent Montini, Julien Bohe, Julio Badie, Jean-Philippe Rigaud, Christophe Vinsonneau, Raphael Porcher, Jean-Pierre Quenot, Didier Dreyfuss
Summary: This study reassessed the impact of choosing intermittent hemodialysis (IHD) or continuous renal replacement therapy (CRRT) as the first modality for patients with severe acute kidney injury (AKI), using secondary analysis of two multicenter randomized controlled trials. The results showed that CRRT as the first modality did not appear to provide a survival advantage or better kidney recovery compared to IHD, and may even be associated with a less favorable outcome in patients with lesser severity of disease.
Article
Urology & Nephrology
Emily See, Claudio Ronco, Rinaldo Bellomo
Summary: Over the last 40 years, CRRT has become the most common form of vital organ support in ICUs, transitioning from basic machines to highly sophisticated devices. Future areas for development include volume control, strategies to minimize circulatory stress, advances in membrane technology, combination with other therapies, and personalization of CRRT delivery.
SEMINARS IN DIALYSIS
(2021)
Article
Medicine, Research & Experimental
Marc Scheen, Grzegorz Nowak, Bienvenido Sanchez, Daniel Teta
Summary: Malignancy-related hypercalcemia is a significant cause of hypercalcemia in hospitalized patients with poor prognosis. This case report highlights the successful use of continuous veno-venous hemodiafiltration with calcium-free dialysate to restore normal calcium levels in a patient with metastatic parathyroid carcinoma and severe refractory hypercalcemia.
EUROPEAN JOURNAL OF MEDICAL RESEARCH
(2022)
Article
Urology & Nephrology
Julie Piotte, Felix Louis, Dimitry Buyansky, Eric Mereniuk, Renee Levesque, Ron Wald, Jean-Francois Cailhier, Jean-Maxime Cote, William Beaubien-Souligny
Summary: This study retrospectively analyzed the use of online hemodiafiltration (HDF) in patients with acute kidney injury (AKI) and found that there was no association between HDF use and mortality or kidney recovery, but it was associated with an increased risk of filter thrombosis.
KIDNEY INTERNATIONAL REPORTS
(2022)
Article
Hematology
Robert Ekart, Luka Varda, Nina Vodosek Hojs, Benjamin Dvorsak, Nejc Piko, Sebastjan Bevc, Radovan Hojs
Summary: In hemodialysis patients with AV fistula, routine measurement of Kt/V during online HDF procedures is beneficial for early detection of hemodynamically significant stenosis in AV fistula. After angioplasty, there was a significant improvement in Kt/V in the active group, with no statistically significant differences in Kt/V between the two groups at 3 and 8 weeks post-procedure.
BLOOD PURIFICATION
(2022)
Article
Hematology
Sergio Dellepiane, Marita Marengo, Mario D'Arezzo, Gabriele Donati, Paolo Fabbrini, Antonio Lacquaniti, Claudio Ronco, Vincenzo Cantaluppi
Summary: This paper assesses the available clinical evidence about medium cut-off (MCO) membranes in chronic hemodialysis (HD) and discusses the next steps needed to use these membranes in HD. The study found a significant degree of consensus on the beneficial role of MCO membranes and expanded HD. Future trial designs and clinical investigations are proposed to improve evidence quality in the current clinical scenario of dialysis units.
BLOOD PURIFICATION
(2022)
Article
Hematology
Anna Lorenzin, Massimo de Cal, Matteo Marcello, David Sorbo, Sabrina Copelli, Claudio Ronco, Silvia de Rosa, Monica Zanella
Summary: Sepsis is a common complication in critically ill patients, and extracorporeal therapies such as hemoperfusion can be used to control infection and provide organ support. This study aimed to determine the amount of vancomycin adsorbed by a sorbent cartridge during hemoperfusion and to establish strategies for maintaining effective plasma levels in critically ill patients.
BLOOD PURIFICATION
(2023)
Review
Hematology
Thiago Reis, Colin Hutchison, Francisco de Assis Rocha Neves, Bruno Zawadzki, Monica Zanella, Claudio Ronco, Mitchell H. Rosner
Summary: A hallmark of chronic kidney disease is the retention of solutes that normally are eliminated by the kidneys. The current classification of uremic toxins based on molecular weight and protein affinity is poorly understood in terms of the role of therapies to reduce uremic toxins in chronic kidney disease patients. Most of the research on lowering serum concentrations of toxic compounds is carried out in patients with kidney failure undergoing kidney replacement therapy. The classification of uremic toxins needs to be updated and the relationship between specific solutes and clinical outcomes needs to be established to develop targeted therapies and improve understanding of the pathogenesis of chronic kidney disease.
BLOOD PURIFICATION
(2023)
Review
Hematology
Faeq Husain-Syed, Raymond Vanholder, Mitchell H. Rosner, Hideki Kawanishi, Tammy Lisa Sirich, Claudio Ronco
Summary: Progress in the identification and characterization of uremic retention solutes has enhanced our understanding of the uremic syndrome. The consensus report recommends improving the definition and classification of uremic toxins and suggests personalized dialysis prescriptions to improve outcomes for CKD patients.
BLOOD PURIFICATION
(2023)
Editorial Material
Hematology
Mitchell H. Rosner, Claudio Ronco
BLOOD PURIFICATION
(2023)
Editorial Material
Hematology
Thiago Reis, Francisco de Assis Rocha Neves, Antonio Fagundes Jr., Emily See, Rogerio da Hora Passos, Bruno Zawadzki, Rinaldo Bellomo, Claudio Ronco
BLOOD PURIFICATION
(2023)
Review
Hematology
Kianoush Kashani, Mario G. G. Cozzolino, Ziad A. A. Massy, Peter J. J. Blankestijn, Peter Stenvinkel, Mitchell H. H. Rosner, Claudio Ronco
Summary: Uremic toxins contribute to clinical manifestations of kidney dysfunction, and their classification should be more clinically focused.
BLOOD PURIFICATION
(2023)
Article
Urology & Nephrology
Anna Giuliani, Silvia Lerco, Sabrina Milan Manani, Matteo Marcello, Ilaria Tantillo, Roberto Nicolin, Claudio Ronco, Monica Zanella
Summary: Peritoneal dialysis (PD) associated peritonitis is a common complication leading to discontinuation of PD. Clostridium difficile colitis is a frequent healthcare-associated infection in patients with end-stage kidney disease. PD patients with Clostridium difficile infection (CDI) present a challenging scenario for antibiotic treatment strategy as broad-spectrum antibiotics may worsen CDI-related colitis, while discontinuation of antibiotic therapy may worsen peritonitis.
PERITONEAL DIALYSIS INTERNATIONAL
(2023)
Article
Hematology
Thiago Reis, Claudio Ronco, Danielle E. Soranno, William Clark, Silvia De Rosa, Lui G. Forni, Anna Lorenzin, Zaccaria Ricci, Gianluca Villa, John A. Kellum, Ravindra Mehta, Mitchell H. Rosner
Summary: A consensus expert conference was convened to develop standardized nomenclature for mechanisms and materials used in extracorporeal blood purification. Standardized nomenclature is crucial for research, education, and innovation coordination.
BLOOD PURIFICATION
(2023)
Review
Urology & Nephrology
Alexander Zarbock, Lui G. Forni, Marlies Ostermann, Claudio Ronco, Sean M. Bagshaw, Ravindra L. Mehta, Rinaldo Bellomo, John A. Kellum
Summary: Acute kidney injury (AKI) is a common clinical condition associated with increased mortality and the risk of developing chronic kidney disease and kidney failure. Currently, there is no specific therapy for AKI and novel interventions targeting the underlying pathophysiology are needed. Well-designed clinical trials with appropriate end points are crucial to evaluate the efficacy of these new interventions and improve outcomes.
NATURE REVIEWS NEPHROLOGY
(2023)
Article
Urology & Nephrology
Sabrina Milan Manani, Maria Mattiotti, Matteo Marcello, Grazia Maria Virzi, Maddalena Gnappi, Davide Marturano, Ilaria Tantillo, Claudio Ronco, Monica Zanella
Summary: A case of Contrast Induced Encephalopathy (CIE) in a Peritoneal Dialysis patient is reported. The patient experienced mental confusion and aphasia after a Percutaneous Angioplasty procedure. Recovery was achieved through medical intervention and additional dialysis.
Article
Cardiac & Cardiovascular Systems
Anna Lorenzin, Luca Sgarabotto, Maria Laura Bacci, Alberto Elmi, Domenico Ventrella, Camilla Aniballi, Monica Zanella, Alessandra Brendolan, Luca Di Lullo, Claudio Ronco
Summary: This study presents a new miniaturized device called AD1 for extracorporeal ultrafiltration, designed for patients with fluid overload. The device operates at low pressure and flow regimes and has a user-friendly interface. The in vivo tests showed that it is safe, reliable, and accurate, opening up possibilities for clinical trials in various settings.
CARDIORENAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Luca Sgarabotto, Amir Kazory, Alessandra Brendolan, Luca Di Lullo, Monica Zanella, Claudio Ronco
Summary: AD 1 is a portable device that can be used to treat patients with fluid overload. It generates ultrafiltrate using a polysulfone mini-filter based on blood flow and gravity. Further studies are needed to evaluate whether gentle ultrafiltration and treatment of volume overload will improve clinical outcomes.
CARDIORENAL MEDICINE
(2023)
Article
Hematology
Krish Vasudev, Amir Kazory, Claudio Ronco, Deepti Bhattacharya, Abhilash Koratala
Summary: Twitter polls help identify knowledge gaps among POCUS learners, leading to improvements in POCUS-related curricula and the development of targeted educational materials to facilitate remote learning.
BLOOD PURIFICATION
(2023)
Article
Cardiac & Cardiovascular Systems
Amir Kazory, Claudio Ronco
Summary: Symptoms and signs of congestion are the main reasons for hospitalization of acute heart failure patients. Loop diuretics are recommended, but their response is variable. Blockade of nephron has been proposed as a more effective strategy. Two large-scale trials examined this hypothesis, targeting the proximal and distal tubules respectively. Results were discussed in the context of previous studies and ultrafiltration.
CARDIORENAL MEDICINE
(2023)