Severe carbamazepine intoxication unresponsive to albumin‐enhanced continuous venovenous hemodiafiltration with low dialysate flow

Carbamazepine (CBZ) intoxication can be associated with severe toxicity, including neurological and cardio‐respiratory abnormalities. Highly protein‐bound, CBZ is not removed efficiently through conventional hemodialysis. Charcoal hemoperfusion is the most effective extracorporeal elimination therapy for CBZ intoxication. Recent reports have indicated that continuous venovenous hemodiafiltration (CVVHDF), albumin‐enhanced continuous venovenous hemodialysis, high‐flux hemodialysis and plasma exchange can be as effective as charcoal hemoperfusion. In contrast to recent reports, which demonstrated the effectiveness of CVVHDF with high dialysate flow in CBZ intoxication, we observed that serum CBZ level was decreased minimally by albumin‐enhanced CVVHDF with low dialysate flow. Therefore, albumin‐enhanced CVVHDF with high dialysate flow should be considered in severe CBZ intoxication, if hemoperfusion is unavailable because of the lack of facilities or if it cannot be performed.     

血液灌流串联血液透析治疗尿毒症顽固性皮肤瘙痒的疗效

目的探讨血液透析（HD）和血液灌流（HP）联合治疗维持性HD尿毒症患者皮肤瘙痒的疗效。方法将45例终末期尿毒症患者按随机数字表法分为2组,观察组（n=23）和对照组（n=22）。2组在营养支持及综合治疗的基础上,对照组采用HD治疗;观察组采用HP＋HD治疗。对2组治疗后3周甲状腺激素（PTH）、β2-微球蛋白（β2-MG）的水平变化以及患者皮肤瘙痒的缓解程度进行比较。结果观察组治疗后3周PTH和β2-MG水平较治疗前及对照组明显下降,皮肤瘙痒症状也较对照组明显改善（均P〈0.05）。结论 HP＋HD联合治疗能显著下降尿毒症患者PTH和β2-MG水平,减轻皮肤瘙痒症状。     

Removal of neutrophil gelatinase‐associated lipocalin by extracorporeal therapies

Neutrophil gelatinase‐associated lipocalin (NGAL) protein is an early biomarker for acute kidney injury (AKI). It is unknown if extracorporeal therapies (EC) have an effect on circulating NGAL levels. This study was designed to describe the kinetics of NGAL molecule in different EC techniques and to evaluate NGAL clearance in different operational conditions. A mock hemofiltration (HF) and hemoperfusion (HP) setup was used. NGAL was added to the blood reservoir and then measured at 30‐minute intervals from arterial, venous, and ultrafiltrate (UF) lines. Removal kinetics and NGAL sieving coefficient were calculated. In our experiments, baseline NGAL concentration averaged 452 μg/L. There was a consistent downward trend throughout the experiment. NGAL concentration in the UF was between 80 and 90 μg/L, though it showed a slight increase in the second hour. The sieving coefficient of NGAL ranged from 0.2 to 0.4 during HF and it appeared to increase with time, suggesting an initial effect of membrane adsorption. HP proved clearly that there was adsorption of NGAL by the membrane and the point of saturation occured at approximately 60 minutes from the start of circulation. Our evaluation demonstrates that NGAL can be adsorbed and ultrafiltrated with polysulfone membranes. This should be taken into consideration when using NGAL as an AKI biomarker in patients undergoing EC circulation.     

Progress of hemoadsorbent materials for hemoperfusion

Hemoperfusion is one type of extracorporeal blood purification therapy. Based on adsorption, the toxins in blood of patients can be efficiently removed by hemoadsorbents. The core of hemoperfusion therapy is the hemoadsorbent materials. The development of high-performance hemoadsorbents will improve the therapeutic efficiency and effect, and reduce or eliminate the severe side effect, thus boosting the development of hemoperfusion technology. Herein, the recent studies of hemoadsorbents are reviewed, including carbon-based materials, polymer-based materials, silica-based materials, molecularly imprinted polymer (MIP)-based materials, adsorption membrane-based materials, novel hemoadsorbents, etc., and the future direction is prospected to provide a guideline for the development of novel hemoadsorbents.     

Theoretical evaluation of the performance characteristics of a combined hemodialysis/hemoperfusion system — I. Single pass flow

A mass transfer model with single pass flow is proposed for evaluating the performance characteristics of a combined system composed of a dialyzer for hemodialysis (HD) and a coated adsorbent packed cartridge for hemoperfusion (HP). In the dialyzer, the mass transfer equation is represented in terms of three dimensionless parameters, i.e., extraction ratio, number of transfer unit, and ratio of flow rates. For the hemoperfusion cartridge, the model equations are derived by formulating the following four processes: convective mass transfer in the bed, fluid phase mass transfer around a coated adsorbent particle, transport across a film of coated membrane, and diffusion within an adsorbent particle. The Freundlich isotherm model is used for the adsorption on adsorbent particles. Applications of the mathematical model to systems to be potentially used in clinical practice are discussed. Solutions for two different sequences of arrangement, i.e., HD-HP and HP-HD, are obtained and discussed in terms of their performance efficacies. Theoretical results demonstrate that the HD-HP arrangement will give better performance in most clinical encounters.     

血液灌流吸附剂材料的研究进展

血液灌流技术是一种将患者血液引出体外，利用吸附剂材料吸附去除血液中的有害物质，使患者血液得到净化的一种血液净化疗法。其核心是其净化装置中的吸附剂材料。高性能血液灌流吸附剂材料的开发，有助于从根本上改善该疗法对患者的治疗效率和效果，并且减少或根除副反应的发生，从而推动血液灌流技术的发展。综述了近年来血液灌流吸附剂材料的相关研究，包括碳基材料、聚合物基材料、二氧化硅基材料、分子印迹聚合物基材料、吸附膜基材料、新型血液灌流吸附剂等，并对未来血液灌流吸附剂材料的发展进行了展望，以期对新型血液灌流吸附剂的开发提供参考。     

Successful treatment of carbamazepine poisoning with hemodialysis: a case report and review of the literature

A 48-year-old man was brought to the emergency room after ingesting an unknown amount of carbamazepine. He was unconscious and not responding to the noxious stimuli. He was intubated and was placed on mechanical ventilation because of respiratory insufficiency. Primary detoxification was performed with a gastric lavage and charcoal instillation. His serum carbamazepine level was 25.6 mcg/mL at the time of admission. His computed tomography of the brain was normal. He was managed conservatively but there was no improvement in his neurological status in the next 24 hours. Serum carbamazepine level was repeated and reported to be 28.3 mcg/mL. As there was no improvement in his sensorium and the serum carbamazepine levels remained persistently high, extracorporeal removal of carbamazepine was attempted. As the facility to carry out hemoperfusion was not available immediately, the decision to initiate hemodialysis was taken. After 3 sessions of hemodialysis, his sensorium improved markedly and the carbamazepine level at this time was within the therapeutic range. He was discharged after psychiatry consultation and counseling. We review the literature regarding extra corporeal techniques for the removal of carbamazepine and discuss them in this article.     

透析方式对尿毒症患者血清糖基化终产物的影响及相关研究

目的比较血液透析（HD）、血液透析滤过（HDF）和血液灌流＋血液透析（HP＋HD）3种血液净化方式对维持性血液透析患者糖基化终产物（AGEs）、肌酐（BUN）和尿素氮（Cr）清除的影响。方法将48例维持性血液透析患者按随机数字表法分成HD组、HDF组、HP＋HD组,每组16例。在透析前后分别取血检测患者AGEs、BUN及Cr。结果 3组患者透析前后比较BUN及Cr均明显下降（P〈0.01）。HDF组和HP＋HD组患者透析前后AGEs显著下降（P〈0.01）,而HD组透析前后AGEs差异无统计学意义（P〉0.05）。结论 HD、HDF、HP＋HD均能有效地清除维持性血液透析患者血液中小分子溶质,而HDF、HP＋HD对AGEs清除能力明显优于HD。     

血液灌流抢救超大剂量地高辛中毒

目的: 观察1例血液灌流抢救超大剂量( 50mg)地高辛中毒的效果。方法: 使用HA 330 ml 灌流器和YT-160 灌流器, 血管通路为股静脉单针双腔导管。入院后共进行了4 次血液灌流( HP) 治疗。结果: 第1 次HP 前后检测地高辛血药浓度均16 μg·L^-1。第2 次HP 血药浓度9. 22 μg·L^-1。第3 次HP 前血药浓度12. 4 μg·L^-1, HP 后为10. 45 μg·L^-1。第4 次HP 前3. 22 μg·L^-1, HP 后为2. 84 μg·L^-1。结论: 采用间隔一定的时间HP, 多次进行, 可阶梯式降低药物浓度。