Blood purification
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In contrast to the general population, in maintenance hemodialysis (MHD) patients, small body size is correlated with reduced survival. The reasons for this association are unclear but may be related to a lower uremic toxin load relative to body weight and a higher distribution volume for uremic toxins in large patients. Since anemia is a salient feature in dialysis patients, this study aimed to explore the relationship between body composition and anemia control. ⋯ Anemia control is related to body composition in Black dialysis patients. EPO requirements and EPO resistance are reduced in patients with high TAT, SAT and MM (the latter in females only). A lower uremic load in large dialysis patients may contribute to these findings.
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Mortality of severe sepsis and septic shock is unacceptably high. Adsorptive removal of endotoxin may interrupt the inflammatory cascade triggered by lipopolysaccharide. ⋯ PSA resulted in a reduction of indicators of oxidative stress and pro-apoptotic activity of the plasma and an improvement in hemodynamic parameters, suggesting increased myocardial contractility and reduced septic vasodilation.
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Comparative Study Controlled Clinical Trial
An observational study on the effects of nadroparin-based and citrate-based continuous venovenous hemofiltration on calcium metabolism.
To study calcium homeostasis during citrate-based compared to nadroparin-based CVVH in critically-ill patients with acute renal failure. ⋯ With a relative low target-serum-iCa (0.8-0.9 mmol/l) citrate CVVH-treated patients had a negative daily calcium balance and a temporarily lower iCa level resulting in an enhanced PTH response in comparison to nadroparin.
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Comparative Study Clinical Trial
Continuous venovenous hemofiltration with or without predilution regional citrate anticoagulation: a prospective study.
Continuous venovenous hemofiltration (CVVH) requires anticoagulation to prevent circuit clotting and its use is contraindicated in patients with high bleeding risk. The aim of this study was to compare CVVH with and without regional citrate anticoagulation (RCA) with respect to filter life, azotemic control and cost. ⋯ Regional anticoagulation with citrate-based replacement solution improved filter life compared to anticoagulant-free predilution CVVH. This regimen appeared safe, feasible and without metabolic complications or increased costs.
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Comparative Study Clinical Trial
Selection of anticoagulants for leukocytapheresis therapy in cases of active ulcerative colitis.
Leukocytapheresis (LCAP) is an extracorporeal leukocyte removal therapy that removes immunocompetent leukocytes from the peripheral blood. Nafamostat mesilate (NM) is the most commonly used anticoagulant for LCAP due to various benefits associated with its use, such as a reduced likelihood of bleeding and minimization of adverse reactions caused by contact between blood and the LCAP device. However, adverse reactions have also been reported with NM administration. We reviewed the safety of anticoagulants other than NM, from the perspective of bradykinin production and the consequent drop in blood pressure during treatment. ⋯ Given the significant benefits of minimized adverse reactions of LCAP and of continuation of LCAP, we suggest that an appropriate selection of the anticoagulant(s) may allow safer execution of LCAP.