Hemoperfusion for the Treatment of Poisoning: Technology, Determinants of Poison Clearance, and Application in Clinical Practice

Abstract

Hemoperfusion is an extracorporeal treatment based on adsorption, historically reserved for the treatment of acute poisonings. Its use was popularized in the 1970s after several in vitro and animal experiments had demonstrated its efficacy, and was even preferred over hemodialysis in the management of overdosed patients. With the advent of new and more efficient dialytic modalities, hemoperfusion is now less frequently performed in the Western world. However, hemoperfusion still remains popular in developing countries. The present article reviews the technique of hemoperfusion, the factors influencing poison clearance through adsorption and its current applications.

Sequential use of hemoperfusion and single-pass albumin dialysis can safely reverse methotrexate nephrotoxicity

“…These complications have been overcome by newer HP cartridges that are coated in thin porous membranes, such as cellulose acetate in the CHP cartridge we have used. Other serious complications such as thrombocytopenia, leukocytopenia, hypocalcemia, hypothermia, and reduction of fibrinogen and hypoglycemia have been reported [6,7]. However, these complications were not observed in our patient.…”

Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Critical Accumulation of Rivaroxaban

“…With its high degree of protein binding of 92–95% [3], rivaroxaban is regarded as non-dialyzable, as also suggested by results from a clinical study conducted by Dias et al [5]. Since protein binding is regarded as not a limiting factor in hemoperfusion [6], the removal of rivaroxaban, as for example by commonly available coated charcoal cartridges, has been deemed possible, but experimental evidence is still lacking [7]. While Andexanet alfa may offer a promising approach to reverse the FXa inhibitor-mediated anticoagulation of rivaroxaban, it has not yet been approved [8].…”

Intermittent haemodialysis and sustained low-efficiency dialysis (SLED) for acute theophylline toxicity

“…Other disadvantages are the high cost of the cartridges relative to dialysis filters and higher doses of anticoagulation required. Increasing use of high-flux haemodialysis technology has seen a decline in the use of charcoal haemoperfusion, along with reduction in availability of charcoal cartridges and the expertise required to use these [11]. In addition to the removal of toxicants, haemodialysis also corrects acid-base and electrolyte disturbances and volume overload.…”