EFFICIENT REMOVAL OF SMALL MOLECULAR WEIGHT PROTEINS (SMWP) WITH A BROAD-SPECTRUM HEMOADSORPTION DEVICE (BetaSorbTM) COMBINED WITH HIGH-FLUX DIALYSIS (HFD) IN ESRD SUBJECTS

Silberzweig, Jeffrey; Brener, Zohar; Kuntsevich, Viktoriya; Quartararo, P; Mok, Wilson; Kaysen, George A.; Winchester, J F; Levin, Nathan W.

doi:10.1097/00002480-200303000-00207

Cited by 3 publications

(6 citation statements)

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“…Table 2 gives the amount of LMWP removed at each session. Significant removal of leptin, angiogenin, retinolbinding protein, IL-18 and complement factor D were observed with combined treatment [37]. Small changes in leukocytes, platelets and albumin were observed.…”

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 92%

“…The adsorptive resins used in the studies [36] described here (BetaSorb™ and CytoSorb™, RenalTech, New York, N.Y., USA), are capable of removing lowmolecular-weight protein toxins from blood, such as ß 2 -microglobulin, leptin, retinol-binding protein, complement factor D, IL-18 and angiogenin [37], as well as the proinflammatory cytokines TNF-·, IL-1ß, IL-6, IL-10 and TNF-· [38][39][40].…”

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 99%

“…In a clinical study [37], 12 ESRD subjects (8 males, 4 females, age 48 B 9 years) were enrolled in a study comparing 1 week of HFD (Fresenius F70NR) with 1 week of HFD combined with a 500-ml adsorption column that removes LMWP from blood (BetaSorb™, RenalTech). Blood flow rate and dialysate flow rate were 400 and 800 ml/min, respectively.…”

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 99%

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Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

et al. 2004

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Renal replacement therapy in acute renal failure (ARF) and chronic renal failure (end-stage renal disease; ESRD) has been based on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle-molecular-weight toxins, consisting of low-molecular-weight proteins and peptides (LMWP) and cytokines involved in inflammation. High-flux dialyzers are not efficient at removing LMWP, and for this reason, sorbents have been studied to augment or replace dialysis. Removal of LMWP such as β₂-microglobulin, leptin, complement factor D, angiogenin and cytokines such as interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-α has been established in animal models of sepsis and in ESRD patients using sorbents. Sorbent devices added to hemodialysis, or the use of such devices alone in inflammatory states, including sepsis, ARF, cardiopulmonary bypass, pre-explantation of donor organs and ESRD, are being studied.

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Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 92%

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 99%

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 99%

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Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

et al. 2004

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“…Similarly, a styrene polymer with an enhanced proportion of mesopores in the range 2 to 20 nm adsorbs high proportions of LMWPs in vitro and in vivo 30 . Experimentally, in man this polymer is capable of removing β2M, angiogenin, retinol‐binding protein, and interleukin‐18, 31 supported by in vitro reduction in monocyte‐derived cytokine production 32 and NF‐κB activation compared with blood contact with cellulosic or polysulfone membranes 33 …”

Section: Removal Of Middle Moleculesmentioning

confidence: 95%

“…29 Similarly, a styrene polymer with an enhanced proportion of mesopores in the range 2 to 20 nm adsorbs high proportions of LMWPs in vitro and in vivo. 30 Experimentally, in man this polymer is capable of removing b2M, angiogenin, retinol-binding protein, and interleukin-18, 31 supported by in vitro reduction in monocyte-derived cytokine production 32 and NF-kB activation compared with blood contact with cellulosic or polysulfone membranes. 33 The Lixelle cartridge (Kaneka Corp., Osaka, Japan) covalently binds b2M and its use over 25 to 62 weeks resulted in symptomatic improvement and partial radiographic improvement in dialysis-related amyloidosis.…”

Section: Removal Of Middle Moleculesmentioning

confidence: 96%

Dialysis desiderata^*

Winchester

Amerling

Dubrow

et al. 2007

Hemodialysis International

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Microarray immunoassay systems, proteomics, separation of polypeptides in plasma by electrophoresis, and detection by mass spectrometry have shown that low molecular weight proteins, cytokines, and chemokines are present in high concentration in chronic kidney disease (CKD) subjects receiving dialysis. That these substances are also found in high concentration in sepsis, postcardiac bypass, acute respiratory distress, burns, and in brain death suggest that these syndromes have a common pathogenesis via a systemic inflammatory response syndrome (SIRS). It is not yet clear whether the profiles of such substances differ among the SIRS states. Dialysis membranes are not capable of removing these substances because such moieties exceed the molecular weight cutoff of modern synthetic hemodialysis membranes. On the other hand, sorbents directly in contact with blood or indirectly with filtered plasma, may be designed with pore structures with the capability of removing these substances. Such sorbents could be exploited in the treatment of CKD. While few human studies have been performed, animal experiments suggest that human trials should be initiated. The potential advantages of sorbents for CKD will be described.

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UNRESOLVED ISSUES IN DIALYSIS: Extracorporeal Strategies for the Removal of Middle Molecules

Winchester

Audia

2006

Seminars in Dialysis

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Uremic toxins with a molecular weight of less than 500 Da are classified as small nitrogenous waste products. They are highly water soluble, relatively homogeneous, and have no protein binding. Other uremic retention toxins differ significantly from the small nitrogenous metabolite class in molecular weight, heterogeneity, protein binding, and hydrophobicity. The European Uremic Toxin Work Group subdivided molecules into two categories: protein-bound solutes and middle molecules. Middle molecules were defined as toxins in the molecular weight range of 500-60,000 Da, which exceeds the molecular weight of 2000 Da defined in the original middle molecule hypothesis. Under this new proposed definition, most of these middle molecules are low molecular weight peptides and proteins (LMWPs). This concise review focuses on LMWPs. The metabolism of LMWPs is described, including molecular weight, physical conformation, and charge. Factors influencing dialytic removal of LMWPs such as membrane characteristics, protein-membrane interactions, and solute removal mechanisms, as well as strategies to enhance clearance of these compounds are discussed.

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EFFICIENT REMOVAL OF SMALL MOLECULAR WEIGHT PROTEINS (SMWP) WITH A BROAD-SPECTRUM HEMOADSORPTION DEVICE (BetaSorbTM) COMBINED WITH HIGH-FLUX DIALYSIS (HFD) IN ESRD SUBJECTS

Cited by 3 publications

References 0 publications

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

Dialysis desiderata^*

UNRESOLVED ISSUES IN DIALYSIS: Extracorporeal Strategies for the Removal of Middle Molecules

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EFFICIENT REMOVAL OF SMALL MOLECULAR WEIGHT PROTEINS (SMWP) WITH A BROAD-SPECTRUM HEMOADSORPTION DEVICE (BetaSorbTM) COMBINED WITH HIGH-FLUX DIALYSIS (HFD) IN ESRD SUBJECTS

Cited by 3 publications

References 0 publications

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

Dialysis desiderata*

UNRESOLVED ISSUES IN DIALYSIS: Extracorporeal Strategies for the Removal of Middle Molecules

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Product

Resources

About

Dialysis desiderata^*