First Clinical Experience with an Adjunctive Hemoperfusion Device Designed Specifically to Remove β&lt;sub&gt;2&lt;/sub&gt;-Microglobulin in Hemodialysis

Ronco, Claudio; Brendolan, Alessandra; Winchester, James F.; Golds, Ellen; Clemmer, J; Polaschegg, Hans‐Dietrich; Muller, Thomas E.; G, La Greca; Levin, Nathan W.

doi:10.1159/000046952

Cited by 41 publications

(3 citation statements)

References 13 publications

(12 reference statements)

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“…Smaller devices are also used for in vitro and in vivo testing. In normal and uremic canines the devices produce about a 30% fall in platelet and leukocyte counts, but no changes occurred ex vivo using human volunteer blood passed over the resin [28] or in vivo during clinical hemodialysis [29]. This confirms the biocompatibility of the coating, and opens the way for extensive clinical testing.…”

Section: Clinical Studies Of Charcoal Hemoperfusion In Uremiamentioning

confidence: 69%

History of Sorbents in Uremia

Winchester

Ronco

Brady

et al. 2001

Contributions to Nephrology

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Section: Clinical Studies Of Charcoal Hemoperfusion In Uremiamentioning

confidence: 69%

History of Sorbents in Uremia

Winchester

Ronco

Brady

et al. 2001

Contributions to Nephrology

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“…An increase of convection, e.g., by the application of on-line hemodiafiltration, could be a valuable approach to increase middle molecule removal [39]. Other options are the development of adsorptive systems [44], and/or the application of alternative hemodialysis schedules [45]. A combination of all these measures will probably be the most effective solution, but also the most expensive.…”

Section: Uremic Toxinsmentioning

confidence: 99%

Uremic Toxins: Removal with Different Therapies

Vanholder

Glorieux

Smet

2003

Hemodialysis International

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A convenient way to classify uremic solutes is to subdivide them according to the physicochemical characteristics influencing their dialytic removal into small water-soluble compounds (<500 Da), protein-bound compounds, and middle molecules (>500 Da). The prototype of small water-soluble solutes remains urea although the proof of its toxicity is scanty. Only a few other water-soluble compounds exert toxicity (e.g., the guanidines, the purines), but most of these are characterized by an intra-dialytic behavior, which is different from that of urea. In addition, the protein-bound compounds and the middle molecules behave in a different way from urea, due to their protein binding and their molecular weights, respectively. Because of these specific removal patterns, it is suggested that new approaches of influencing uremic solute concentration should be explored, such as specific adsorptive systems, alternative dialytic timeframes, removal by intestinal adsorption, modification of toxin, or general metabolism by drug administration. Middle molecule removal has been improved by the introduction of large pore, high-flux membranes, but this approach seems to have come close to its maximal removal capacity, whereas multicompartmental behavior might become an additional factor hampering attempts to decrease toxin concentration. Hence, further enhancement of uremic toxin removal should be pursued by the introduction of alternative concepts of elimination.

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“…After the sorbent cartridge, blood is reconstituted so that red cells, white cells, and platelets never meet the sorbent surface, and bio-incompatibility reactions are avoided [ 7 ]. Alternatively, the sorbent is made biocompatible by a specific coating process covering the particles with bio-layers that are well tolerated by blood cells [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Hemoperfusion: technical aspects and state of the art

Ronco

Bellomo

2022

Crit Care

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Background Blood purification through the removal of plasma solutes by adsorption to beads of charcoal or resins contained in a cartridge (hemoperfusion) has a long and imperfect history. Developments in production and coating technology, however, have recently increased the biocompatibility of sorbents and have spurred renewed interest in hemoperfusion. Methods We performed a narrative assessment of the literature with focus on the technology, characteristics, and principles of hemoperfusion. We assessed publications in ex vivo, animal, and human studies. We synthesized such literature in a technical and state-of-the-art summary. Results Early hemoperfusion studies were hampered by bioincompatibility. Recent technology, however, has improved its safety. Hemoperfusion has been used with positive effects in chronic dialysis and chronic liver disease. It has also demonstrated extraction of a variety of toxins and drugs during episodes of overdose. Trials with endotoxin binding polymyxin B have shown mixed results in septic shock and are under active investigation. The role of non-selective hemoperfusion in sepsis or inflammation remains. Although new technologies have made sorbents more biocompatible, the research agenda in the field remains vast. Conclusion New sorbents markedly differ from those used in the past because of greater biocompatibility and safety. Initial studies of novel sorbent-based hemoperfusion show some promise in specific chronic conditions and some acute states. Systematic studies of novel sorbent-based hemoperfusion are now both necessary and justified.

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First Clinical Experience with an Adjunctive Hemoperfusion Device Designed Specifically to Remove β<sub>2</sub>-Microglobulin in Hemodialysis

Cited by 41 publications

References 13 publications

History of Sorbents in Uremia

History of Sorbents in Uremia

Uremic Toxins: Removal with Different Therapies

Hemoperfusion: technical aspects and state of the art

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