Effect of Continuous Renal Replacement Therapy with the oXiris Hemofilter on Critically Ill Patients: A Narrative Review

Abstract

Critically ill patients with sepsis and severe COVID-19 are commonly characterized by a dysregulated immune response and an acute kidney injury. Continuous renal replacement therapy (CRRT) is now proposed as a promising adjuvant therapy to treat these critically ill patients by removing cytokines, pathogen-associated molecular patterns, and damage-associated molecular patterns from the blood. Although multiple hemofilters, including high-cutoff membranes, the oXiris hemofilter, the CytoSorb hemoadsorption device, and the Toraymyxin hemoperfusion cartridge, have been used in current clinical practice, the use of the oXiris hemofilter in critically ill patients is of particular interest because it is the only kind of hemofilter that can provide renal replacement therapy, remove endotoxins, and adsorb cytokines simultaneously. During the past five years, a growing body of literature has shown that CRRT with the oXiris hemofilter can improve hemodynamics and organ function and can decrease cytokines and endotoxins in both septic and COVID-19 patients. Here, we performed a narrative review to describe the development history of the oXiris hemofilter and to discuss the therapeutic effect of oXiris-CRRT on critically ill patients by searching the PubMed, Web of Science, and clinicaltrials.gov databases for articles published from inception to 8 September 2022 (updated on 1 November) with an English language restriction. We also summarized the current knowledge on anticoagulation techniques and safety concerns when delivering oXiris-CRRT sessions.

Targeting circulating high mobility group box-1 and histones by extracorporeal blood purification as an immunomodulation strategy against critical illnesses

“…Indeed, a failure to show a survival effect by a certain therapeutic regimen does not simply mean that the regimen is worthless. Future randomized controlled trials should also assess different primary endpoints, such as the number of ventilation-free days, vasopressor therapy-free days, and ICU-free days and the changes of plasma inflammatory mediators, to shed light on other important effects of EBP on critically ill patients [ 7 , 114 ]. Taken together, the removal of DAMPs during extracorporeal blood purification in critically ill patients with immune dysregulation should be individualized and dynamically changed, and adequate selection of the patient population, treatment dose and type of hemofilters is critically needed.…”

“…Further clinical studies are urgently needed to evaluate the impact of the use of the AN69ST membrane to remove HMGB1 on patient-centered clinical outcomes. As the polyethyleneimine layer of the AN69ST membrane can also adsorb heparin to allow heparin priming before use [ 7 ], it is also of clinical significance to further determine whether the use of the AN69ST hemofilter is able to remove positively charged histones by the primed heparin layer from the blood of critically ill patients receiving continuous renal replacement therapy.…”

“…Currently, EBP uses a series of hemofilters to remove hydrophilic or hydrophobic solutes through the mechanism of convection, diffusion or adsorption, and the solute removal spectrum of a hemofilter is significantly dependent on its own membrane/adsorbent structure and treatment dose [ 6 ]. Multiple hemofilters, such as Toraymyxin hemofilter (Toray Industries, Tokyo, Japan), the CytoSorb hemofilter (CytoSorbents Corporation, New Jersey, USA) and the oXiris hemofilter (Baxter, Meyzieu, France), have been used to treat critically ill patients in current clinical practice aiming to eliminate endotoxins and/or cytokines despite the lack of solid evidence of survival benefit [ 3 , 7 ]. The failure of EBP therapies to improve survival in these patients could be attributed to the inadequate timing for treatment initiation, inadequate patient selection, inadequate therapeutic target selection and insufficient clearance of inflammatory mediators [ 3 , 5 ].…”

The separation membranes in artificial organs

“…Additionally, the surface is pre-connected with heparin to facilitate anticoagulation in extracorporeal circulation, enhancing the hemocompatibility and biocompatibility of the membrane material. 45 The oXiris membrane material is already available in Europe and China, and several small clinical studies and randomized controlled animal trials have confirmed its good clinical hemodialysis performance. 46 In 2017, Wang et al 47 fabricated a thin film nanofiber composite (TFNC) membrane with a two-layer composite structure for hemodialysis.…”

Advances in Enhancing Hemocompatibility of Hemodialysis Hollow-Fiber Membranes

“…The AN69 membrane is symmetric and homogeneous with a high density of medium-sized pores, making it highly permeable not only to large solutes but also to the fluid. Uniquely, the AN69 membrane is able to remove low/medium-molecular-weight β 2 -microglobulin and inflammatory cytokines by membrane adsorption through electrostatic binding with negative sulfonic groups as well as by transmembrane transport [ 29 ]. Owing to these unique membrane characteristics, the latest surface-treated AN69 membrane, namely the oXiris membrane, has been widely used for RRT of critically ill patients with sepsis or COVID-19 [ 29 ].…”