Emerging Therapies for Extracorporeal Support

Abstract

Dialytic therapies have undergone major technological developments in the last decade and emerging techniques are promoted not only for acute kidney injury, but also for sepsis, acute decompensated heart failure, and acute and acute-on-chronic liver failure. New devices specifically target the pathophysiological mechanisms involved in these conditions. In septic shock and sepsis, high-volume hemofiltration, coupled plasma filtration adsorption, cascade hemofiltration and high permeability hemofiltration enhance removal of pro-inflammatory mediators, while in liver failure, Molecular Adsorbents recycling System (MARS®) and Prometheus® favor the elimination of albumin-bound toxins such as bilirubin. In acute decompensated heart failure, simplified ultrafiltration machines are used to reach negative fluid balance in a minimalist setting. In the context of limited resources and growing expansion in the availability of technologies, a critical assessment is required and the use of these devices needs to be put in perspective. This article reviews the mechanisms, advantages and limitations of these techniques along with the current evidence available regarding their influence on major clinical outcomes.

Proteomics analysis of the peritoneal dialysate effluent reveals the presence of calcium-regulation proteins and acute inflammatory response

“…When there is renal failure, removal of these toxins from blood circulation can be done by effective methods, as extracorporeal blood purification and peritoneal dialysis (PD). Both methods are mainly used as renal replacement therapy, as artificial kidney, in patients with end-stage renal disease and acute kidney injury [ 9 - 12 ].…”

External Inosculation as a Feature of Revascularization Occurs After Free Transplantation of Murine Liver Grafts

“…For these reasons, alternative strategies are currently under investigation, either to assure a temporal bridging of patients until transplantation or to restore the complex liver function in a long-term view (2). Classical nonbiological (artificial) bridging procedures serving for extracorporeal blood purification are plasma exchange, hemodialysis and hemofiltration techniques (3,4). The introduction of the molecular adsorbents recirculating system (MARS) and the Prometheus system offered new possibilities in the field of dialysis (5,6).…”

Hemofiltración de alto volumen en shock séptico

“…En este artículo de revisión analizaremos la fundamentación fisiopatológica para el empleo de la HFAV, las hipótesis planteadas para la eliminación de mediadores inflamatorios y su consiguiente efecto inmunomodulador y los estudios experimentales y clínicos en pacientes con shock séptico. Nosotros no discutiremos sobre el rol de otras técnicas depurativas en el tratamiento de la sepsis, para lo que indicamos a los lectores remitirse a trabajos específicos recientemente publicados [41][42][43] .…”