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Coupled Plasma Filtration Adsorption Application for Liver and Thyroid Toxins
No full textCoupled plasma filtration and adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit and a continuous renal replacement therapy circuit. Its main application is for sepsis and septic shock with or without acute renal failure. Several recent studies have suggested that CPFA can reduce the mortality when the volume of plasma absorbed on the styrenic resin is at least >0.18 L/kg/day. At present, new applications for CPFA are under investigation, also in patients without significant kidney failure. We report here a successful case of CPFA use during acute liver failure, with a complete recovery of liver function in a patient after severe cholangitis and relapsing hemolytic anemia. The resin enabled the removal of bilirubin and protein-bound toxins, while the hemofilter removed the hydrophilic toxins such as ammonia and non-protein-bound toxins as free bilirubin. We also describe a second case of CPFA application during thyrotoxicosis to achieve free triiodothyronine (FT3) and free thyroxin (FT4) adsorptions. The CPFA efficacy seems to exceed that obtained by plasma exchange (PEX) as to FT3 and FT4 adsorptions. The resin allowed the adsorption of FT3 and FT4. The role of the hemofilter is to enhance the hemodynamic tolerance of the extracorporeal treatment and remove water-soluble toxins. The reduced duration of CPFA treatments, in case of normal renal function, is confirmed by the assessment of the resin cartridge saturation. Thus, multipurpose CPFA can play a role in the case of resistance to current medical therapy or as a bridge to liver transplantation or thyroidectomy
Rimozione di fibroblast growth factor 23 (FGF23) nel paziente in emodialisi: tecniche dialitiche a confronto
No full textRimozione di medie molecole e anticoagulazione in emodialisi con membrane a medio cut-off: risultati preliminari di uno studio monocentrico
No full textDialyzability of Oxycodone and Its Metabolites in Chronic Noncancer Pain Patients with End-Stage Renal Disease
No full textObjectives: Opioids are the preferred analgesic drugs to treat severe chronic pain conditions among dialysis patients; however, knowledge about their dialyzability features is limited. Oxycodone is increasingly used for the treatment of chronic pain conditions as oral controlled release (CR) tablets; however, evidence about this drug and its metabolites' dialyzability is lacking. Methods: We assessed, during 4-hour dialysis sessions, the effect of standard hemodialysis (HD) and online hemodiafiltration (HDF) methods on the plasma concentration of oxycodone and its metabolites in n = 20 chronic pain patients with end-stage renal disease who were stably treated with oral CR oxycodone. Chromatographic techniques were used to evaluate the studied compounds' plasma concentrations at three different time points during dialysis. Results: Mean plasma concentrations of oxycodone and noroxycodone in the sample showed an overall reduction trend over time, but it was less enhanced for noroxycodone. Mean reduction in oxycodone and noroxycodone arterial concentrations was significant and higher with HDF (54% and 27%, respectively) than with HD (22% and 17%, respectively). Analysis of the regression of these compounds' clearance on their increasing arterial concentration showed a more stable and linear clearance prediction with HDF (roughly 85 mL/min); with HD, for increasing arterial concentration, clearance of oxycodone decreased while noroxycodone clearance increased. Discussion: While no oxymorphone or noroxymorphone metabolites were detected, limited dialyzability of oxycodone and noroxycodone was documented along with insignificant postdialysis pain increment. This evidence will contribute toward considerations as to the safety of the use of oxycodone in dialysis patients in the future
Octogenarians in pre-dialysis phase do not have worse results of radio cephalic arteriovenous fistula compared to younger patients
No full textHEPATIC REGENERATION WITH COUPLED PLASMAFILTRATION AND ADSORPTION FOR LIVER EXTRACORPOREAL DETOXIFICATION (HERCOLE STUDY)
No full textQTC INTERVAL, POTASSIUM AND ELECTROLYTES KINETICS DURING AND AFTER DIALYSIS WITH SUPRA HFR (PANDORA STUDY)
No full textBackground and Aims:
The QTc interval is a marker of arrhythmic risk in dialysis patients and its lengthening has been associated with an increased risk of sudden death [1]. This phenomenon could be due to accumulation of uremic toxins and their rapid removal with dialysis causing imbalance of electrolytes currents [2].
The aim of the study is to describe the kinetics of potassium (K+) and other electrolytes during and after dialysis with the goal of validate a mathematical model for predicting the respective kinetics [3]. The secondary endpoint is to identify a correlation between the kinetics of intra (Ki) and extracellular K+ (Ke) during and after dialysis and QTc interval.
Method:
6 anuric HD patients were enrolled in a interventional, exploratory, prospective study. Clinical and pharmacological factors favouring the onset of arrhythmias or influencing the total mass of K+ were excluded.
Ki and Ke, Ca2+, Na, blood gas analysis, glucose and urea every 30 minutes were assessed during a 4 hour HFR Supra dialysis session, the subsequent 7 hours and at the start of the following session after 48 hours. A 12 lead ECG were performed with the same schedule and a bioimpedance vector analysis (BIVA) was obtained at the start and the end of the dialysis and 1- and 7-hours after dialysis. Dialysate electrolytes were: Na 140 mEq/L, K 3 mEq/L, Ca2+ 1.5 mEq/L, HCO3- 30 mmol/L.
A selective ion probe was used to measure K+, the Ki value was obtained by an indirect formula expressed in a previous study [4].
The model of K+ kinetics includes the Na + / K + / ATPase-dependent pump, the passive diffusion of K+ from the intracellular to the extracellular compartment, the diffusion of K+ through the filter, the intradialytic volume variation, the K+ and solute rebound after dialysis, the role of plasma osmolality [3].
Results:
The model showed a better correlation to the in vivo data during the HFR phase than the post dialytic one regarding Ke, sodium, HCO3- and Ca2+. The wide variability recorded by Ki is significantly in contrast with the stability predicted by the model and the entity of post dialysis Ca2+ drop was greater than that predicted by the model. Kinetics prediction of urea had a precise fitting with in vivo data in every phase.
In Table 1 are resumed the in vivo results of the 5 patients regarding Ke, Ki, Ki/Ke, Ca2+ and QTc during and after HFR. In Figure 1 we see the data extrapolated from a patient (likewise the others), where the greatest waving of the QTc occurred in the first hour post HFR in parallel with fluctuations of Ki and Ki/Ke.
Conclusion:
The mathematical model for the prediction of the kinetics of solutes has shown a good correspondence with the in vivo data of K+, sodium, urea, Ca2+ and HCO3- during HFR, while it still needs to be refined in the post-dialysis phase. The major discrepancies for Ki could be due to difficult analytical processing.
As to the greater drop of Ca2+ compared to the predicted, it can be due to the role played by other Ca2+ compartments in addition to the intra and extracellular ones.
Although during the intradialytic period we faced a shortening of the QTc interval with a significant reduction in Ke, greater Ki/Ke and an increase in Ca2+, the post HFR period appeared to be the most critical period. This phase corresponded to the largest fluctuations in QTc values, Ki, Ki / Ke ratio, and to the rapid rebound of K+ and the drop of Ca2+
Effetti della emodiafiltrazione on-line sulla concentrazione plasmatica dell'ossicodone in pazienti con dolore moderato severo: risultati preliminari
No full textDepurazione extracorporea mediante Coupled plasma filtration and adsorption (CPFA) in corso di insufficienza epatica acuta e acuta su cronica (studio HERCOLE)
No full textRimozione delle catene leggere libere mediante diverse tipologie di filtri dializzatori in pazienti con danno renale acuto da mieloma multiplo
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