Citrate Extended High Cut‐Off Hemodiafiltration for Renal Recovery in Patients With Multiple Myeloma

Pernat, Andreja Marn; Medved, Bojan; Gubenšek, Jakob; Premru, Vladimir; Knap, Bojan; Buturović‐Ponikvar, Jadranka; Ponikvar, Rafael

doi:10.1111/1744-9987.12432

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…In comparison with calcium balance, magnesium balance during intermittent HD has been studied in less detail: there is some data on the effect of RCA on serum magnesium levels in intermittent HD [12,21], but the topic has received scant attention. [23] It is important to emphasize that hypomagnesemia is not to be ignored, since some cohort studies have reported that lower serum magnesium levels are associated with an increased risk of all-cause and cardiovascular mortality among HD patients.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Given all its benefits, citrate has already become the standard anticoagulant in acute kidney injury requiring continuous renal replacement therapy, not only for adults [7], but also for pediatric patients [8]. Furthermore, RCA is being increasingly used in various intermittent HD modalities, such as chronic high-flux [6,9,10] and lowflux HD [11], hemodiafiltration with a high cut-off (Ther-alite®) membrane [12], and single-needle HD [13].…”

Section: Introductionmentioning

confidence: 99%

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Use of regional citrate anticoagulation with medium cut-off membrane: pilot report

2022

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Background Regional citrate anticoagulation during hemodialysis provides an immediate and complete anticoagulant effect, which is limited to the extracorporeal circuit. Citrate has become the standard anticoagulant in acute renal replacement therapy and is widely used in various intermittent hemodialysis modalities, especially for patients with contraindications for heparin. With the increased adoption of medium cut-off membranes, experience with regional citrate anticoagulation is needed. To our knowledge, this is the first report to assess the feasibility of regional citrate anticoagulation in expanded hemodialysis. Methods We prospectively analyzed 5 expanded hemodialysis procedures in 5 patients in which a medium cut-off membrane (Theranova®) was used. We followed our standard citrate protocol developed and tested for high-flux membrane. Anticoagulation was performed with a continuous infusion of 8% trisodium citrate into the arterial line and supplementation of 1 M calcium chloride into the venous line. We monitored ionized calcium and magnesium, sodium and blood gas analysis. Anticoagulation effectiveness was assessed by post-filter ionized calcium and by visual inspection of the anticoagulation in the circuit. Results There were no prematurely terminated procedures due to anticoagulation-related complications. With a blood flow of 250 mL/min and a dialysate flow of 500 mL/min, we were able to maintain serum ionized calcium in the range of 0.89–1.29 mmol/L and serum sodium in the range of 136–144 mmol/L. The mean pre- and post-dialysis arterial circuit pH was 7.42 (± 0.04) and 7.53 (± 0.23), respectively. The mean pre- and post-dialysis serum ionized magnesium was 0.54 (± 0.04) mmol/L and 0.43 (± 0.03) mmol/L, respectively (measurements were done on a point-of-care ionometer with a lower normal range for ionized magnesium). Conclusion We have shown that our standard citrate protocol for high-flux hemodialysis membrane could be successfully adopted for use in expanded hemodialysis with a medium cut-off membrane. Overall, electrolyte and acid-base balances were relatively well-controlled and anticoagulation effectiveness was excellent. Trial registration This is a pilot report with results taken from a larger ongoing trial (registered at ClinicalTrials.gov on October 25, 2019 under number NCT04139525) comparing citrate and heparin anticoagulation during expanded hemodialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Use of regional citrate anticoagulation with medium cut-off membrane: pilot report

2022

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“…Blood and dialysate flow were set to 250–350 and 500 ml/min, respectively, with ultrafiltration performed according to clinical needs. There is also a study that applied HCO membranes in post-dilution hemodiafiltration in MM patients with AKI ( 52 ).…”

Section: Protocols For Hco-hdmentioning

confidence: 99%

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

Xing

Yan²,

Yu³

et al. 2022

Front. Oncol.

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Multiple myeloma (MM), an incurable hematological malignancy with clonal proliferation of plasma cells, is mainly characterized by excessive production of monoclonal immunoglobulins and free light chains (FLCs). Kidney injury is one of the main clinical manifestations and is also a significant predictor of the prognosis of symptomatic MM patients, especially those who require dialysis-supported treatment. Overproduction of FLCs is the trigger for kidney injury, as they can induce the transcription of inflammatory and profibrotic cytokines in the proximal tubule and bind to Tamm–Horsfall protein in the distal tubules to form casts that obstruct the tubules, leading to kidney injury and even renal fibrosis. In addition to traditional antimyeloma treatment, high-cutoff hemodialysis (HCO-HD), which can effectively remove FLCs in vitro, has attracted much attention in recent years. Due to its greater membrane pore size, it has significant advantages in removing larger molecules and can be applied in rhabdomyolysis, sepsis, and even myeloma cast nephropathy. However, mounting questions have recently been raised regarding whether HCO-HD can truly provide clinical benefits in MM patients with acute kidney injury (AKI). Therefore, in this study, we discussed the pathological causes of AKI secondary to MM and summarized the current situation of HCO-HD in MM patients compared with other available extracorporeal techniques. In addition, pivotal clinical trials that reflect the ability of the clearance of FLCs and the side effects of HCO-HD are highlighted, and the relevant protocol of HCO-HD is also provided to assist clinicians in decision-making.

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“…[8][9][10] Conventional HD with High-flux (HF) membranes eliminates such mediators insufficiently, their accumulation may lead to elevated synthesis of hepatic CRP. 11,12 High cut-off (HCO) membranes, 13,14 especially those with a nominal cut off point of 45 kDa (HCO1100, Gambro), have been successfully employed for the treatment of light-chain nephropathy in patients with multiple myeloma [15][16][17][18][19][20] and of septic shock. 21,22 Their ability to remove large quantities of inflammation mediators makes the HCO membranes a promising tool for chronic HD patients with elevated CRP level.…”

Section: Introductionmentioning

confidence: 99%

Impact of serum and dialysates obtained from chronic hemodialysis patients maintained on high cut‐off membranes on inflammation profile in human THP‐1 monocytes

Trojanowicz

Ulrich

Fiedler

et al. 2016

Hemodialysis International

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Citrate Extended High Cut‐Off Hemodiafiltration for Renal Recovery in Patients With Multiple Myeloma

Cited by 4 publications

References 16 publications

Use of regional citrate anticoagulation with medium cut-off membrane: pilot report

Use of regional citrate anticoagulation with medium cut-off membrane: pilot report

High-cutoff hemodialysis in multiple myeloma patients with acute kidney injury

Impact of serum and dialysates obtained from chronic hemodialysis patients maintained on high cut‐off membranes on inflammation profile in human THP‐1 monocytes

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