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Hemoperfusion for
Sepsis and SA-AKI
Grace Zhang
Jafron Biomedical Co., Ltd., China
Causes of AKI
2012 KDIGO
Mechanism of Sepsis
Microbial insult(Endotoxin-LPS/endotoxin-peptidoglycan)
Pro-inflammatory state
Anti-inflammatory state
Sepsis Associated Acute Kidney Injury(SA-AKI), Multiple Organ Failure(MOF) & Death
Zarjou A, Agarwal A. Sepsis and acute kidney injury. Journal of the American Society of Nephrology Jasn, 2011, 22(6): 999-1006.
Common blood purification methods
β2-MG:3.442nm
Pore size:20-50nm
Inflammatory mediators
Methods:
• Monocytes were exposed to the sorbent material in static and dynamic manners.
• In static test, cell medium samples were collected after 24 h of incubation in the cartridges.
• In dynamic test, HP modality has been carried out and samples at 30, 60, 90, and 120 min were collected.
Safety of Jafron Cartridges
Results:
Compared to control samples,
there was no evidence of
increased necrosis or
apoptosis in monocytes
exposed to the cartridges both
in the static and dynamic tests.
Conclusion:
Our in vitro testing suggests that HA cartridges carry an optimal level of biocompatibility and
their use in HP is not associated with adverse reactions or signs of cytotoxicity.
HA330 for Sepsis
Design:
A prospective randomized, parallel
controlled analysis.
N=46
N(Control)=21
standard therapy included
fluid resuscitation, vasopressors,
antimicrobial therapy, ventilatory, etc.
N(HP)=25;
HP once a day for three consecutive
days after admission to the intensive
care unit.& standard therapy
Follow-up:28 days
Outcome:
• Cytokines
• Organ Function
• Survival
Design:
A prospective randomized, controlled analysis.
N=40
N(Control)=18
standard therapy
N(HP)=22;
HP once a day for three days, each session lasts 2h
Follow-up:2 weeks
Outcome:
• Cytokines
• Organ Function
Huang Zhao etc. China J Emerg Med, January 2011, Vol. 20, No.01
HA330 for Sepsis Induced AKI
Huang Zhao etc. China J Emerg Med, January 2011, Vol. 20, No.01
HA330 for Sepsis Induced AKI
Huang Zhao etc. China J Emerg Med, January 2011, Vol. 20, No.01
HA330 for Sepsis Induced AKI
Huang Zhao etc. China J Emerg Med, January 2011, Vol. 20, No.01
From Single to Hybrid
HD/CVVH… Hemoperfusion
• Strengths: effective clearance of water- • Strength: effective clearance of medium-to-
soluble and low protein substances, correct macro, protein-bound toxins and fat soluble
water-electrolyte imbalance. substances.
• Weakness: inefficiency clearance of macro
• Weakness: it can not regulate water-
molecules and fat soluble toxins.
electrolyte, acid-base balance.
HP+CVVH/HDF/HD/…
HDF+HP VS CVVH for SA-AKI
Design:
A prospective randomized, parallel controlled analysis.
Tab.2 Changes of APACHE II
N=58
N(control)=29 APACHEII
Standard therapy + CVVH treatment for 24h Group Pre- 7 days 14 days
treatment post treatment post treatment
N(HDF+HP)=29;
HDF+HP
HP for 2h first, HDF treatment for 8-12h
CVVH
Follow-up:28 days
①Compared to Pre-treatment, P<0.05;
Outcome: ②Compared to control group, P<0.05
• Inflammatory mediators
• Organ function
• APACHE-II score
HD+HP treatment better decreases APACHE-II
• 28-day survival rate score than CVVH treatment significantly.
Modern Journal of Integrated Traditional Chinese and Western Medicine 2017 Nov, 26(32)
HDF+HP VS CVVH for SA-AKI
Tab.3 Comparison of Urine Volume and Kidney Function Pre & Post Treatment
Scr HDF+HP
( μmol /L)
CVVH
BUN HDF+HP
( mmol /L) CVVH
Better improved kidney
HDF+HP
Urine NAG function in HD+HP group
(IU/L) CVVH
Γ-GTP HDF+HP
(IU/L) CVVH
HDF+HP
A1-MG
(mg/L) CVVH
HDF+HP
Urine Volume
(mL/d) CVVH
Modern Journal of Integrated Traditional Chinese and Western Medicine 2017 Nov, 26(32)
HDF+HP VS CVVH for SA-AKI
Group Time
Pre-
treatment
HDF+HP Post-
treatment
Pre-
treatment
CVVH
Post-
treatment
Modern Journal of Integrated Traditional Chinese and Western Medicine 2017 Nov, 26(32)
HDF+HP VS CVVH for SA-AKI
28-day survival
70 65.5%
60
50
37.9%
40 Better 28-day survival rate shows in
30 HDF+HP group with significant difference.
20
10
0
CVVH HDF+HP (P<0.05)
Conclusion:
HDF + HP for the patients with sepsis induced AKI can
• effectively prevent further deterioration of renal function
• promote renal function recovery
• effectively remove inflammatory factors and improve inflammation in the body.
The combination of HDF+HP is safe which can be used as an alternative treatment
for patients with sepsis induced AKI.
Further study with larger samples and long-term observation is expected.
Modern Journal of Integrated Traditional Chinese and Western Medicine 2017 Nov, 26(32)
Summary
Stabilize hemodynamic
BMJ 2019;364:k4891
HD/HDF+HP for ESRD
Comprehensive removal of uremic toxins