The International journal of artificial organs
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The objective of this study was to investigate retrospectively the effect of direct hemoperfusion using polymyxin B immobilized fiber (PMX-DHP) in a cartridge to remove endotoxin on inflammatory mediators in septic patients. PMX-DHP was performed 59 times in 40 patients with severe sepsis and septic shock due to gram-negative bacterial infection. Mean age and APACHE II score were 63 years and 22, respectively. ⋯ Blood pyruvate also decreased significantly (p=0.0025). At the same time, mean arterial pressure, pulse pressure, systemic vascular resistance index, and urine output were significantly increased. These results indicated that PMX-DHP could decrease inflammatory mediators and be effective to interrupt the pathogenic sequence leading to septic shock due to gram-negative bacterial infection.
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The most serious problem related to the use of tunneled catheters in hemodialysis is bacteremia. The aim of this study was to detect hemodialysis catheter colonization and, establish a preemptive therapy based on a catheter antibiotic lock in order to prevent development of catheter-related bloodstream infections. During a 24-month period, all patients with tunneled catheters in our hemodialysis unit were evaluated by extracting a through-catheter leukocyte culture every 15 days. ⋯ The incidence of catheter-related bloodstream infection in our population was 0.78 episodes per 1000 catheter patient-days (IC 95%: 0.374-1.434). This study shows the utility of intra-catheter leukocyte culture for early detection of hemodialysis catheter colonization. Moreover, it establishes that the eradication of biofilm-related CNS is possible without the removal of the catheter, thus enabling a longer catheter lifespan.
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Renal replacement therapy (RRT) is required in a significant percentage of patients developing acute kidney injury (AKI) in an intensive care unit (ICU) setting. One of the foremost objectives of continuous renal replacement therapy (CRRT) is the removal of excess fluid and blood solutes that are retained as a consequence of decreased or absent glomerular filtration. ⋯ The following provides an overview of solute and water transfer during CRRT and this information is placed in the appropriate clinical context with a discussion of recent clinical trials assessing the relationship between CRRT dose and patient survival. Moreover, the differences between solute removal in CRRT and other dialysis modalities, especially sustained low-efficiency dialysis (SLED) and extended daily dialysis (EDD), along with the potential clinical implications are discussed.
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Randomized Controlled Trial
Regional citrate anticoagulation for hemodialysis: calcium-free vs. calcium containing dialysate - a randomized trial.
The majority of citrate protocols for hemodialysis (HD) use calcium (Ca)-free dialysate, a limited number use dialysate with Ca, aiming to simplify the procedure. This randomized clinical study sought to compare the anticoagulant effect of citrate using Ca-free dialysate and dialysate with Ca 1.25 mmol/L. ⋯ Citrate anticoagulation with Ca-1.25 dialysate resulted in significantly worse anticoagulation of dialyzer and venous bubble trap compared with Ca-free dialysate, despite higher citrate dose.