Blood purification
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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.
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Review Comparative Study
Recent clinical advances in the management of critically ill patients with acute renal failure.
Significant progress has been made in the field of renal replacement therapy for critically ill patients with acute renal failure (ARF) over the past few years. This review highlights these developments. ⋯ Based on recent clinical studies, the increasing use of the RIFLE criteria is justified, as this approach appears to be a robust method for both the diagnosis of and prognostication in ARF. A large randomized trial involving convective CRRT supports the commonly used prescription of 35 ml/ kg/h in clinical practice. Moreover, numerous recent outcome studies, also largely involving convective CRRT, provide a clinical rationale for the increasingly common clinical practice of earlier initiation. Finally, several recent studies suggest CRRT, relative to conventional hemodialysis, results in a greater rate of renal recovery in ARF patients.
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Randomized Controlled Trial
Homocysteine-lowering vitamin B treatment decreases cardiovascular events in hemodialysis patients.
Dialysis patients have higher cardiovascular events rate than patients with normal renal function. Hyperhomocysteinemia, a risk factor for cardiovascular disease, is frequently detected in dialysis patients. Vitamin B supplementation lowers hyperhomocysteinemia, but it is unknown whether it reduces cardiovascular events rate. We planned a long-term study to analyze the effects of homocysteine-lowering vitamin B therapy on cardiovascular disease in hemodialysis patients. ⋯ This trial shows for the first time that homocysteine-lowering folate therapy decreases cardiovascular events in dialysis patients. It is necessary to perform large prospective studies to confirm our results.
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It was the aim of this study to observe the effects of sequential hemoperfusion (HP) and continuous venovenous hemofiltration (CVVH) on patients with severe tetramine poisoning and to evaluate the ability of these modalities to remove tetramine. ⋯ Early sequential HP and CVVH therapy may significantly improve the outcome of patients with severe tetramine intoxication. HP can rapidly reduce the plasma concentration of tetramine, and CVVH can attenuate the plasma tetramine concentration rebound after HP by continuously removing tetramine from the plasma.