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Lemoine S, Penny J, Fraser DD, Salerno FR, Dorie J, Tamasi T, Arntfield R, House A, Slessarev M, McIntyre CW. Initial evaluation of extracorporeal immunomodulatory therapy for the treatment of critically ill COVID-19 infected patients. Sci Rep 2022; 12:20236. [PMID: 36424380 PMCID: PMC9684905 DOI: 10.1038/s41598-022-21944-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 10/06/2022] [Indexed: 11/27/2022] Open
Abstract
Severe COVID-19 infection results in significant immune dysregulation resulting from excessive recruitment and activation of neutrophils. The aim of this study was to confirm feasibility, initial safety and detect signal of efficacy of a non-propriety device delivered using an intermittent extra-corporeal system (LMOD) allowing leucocytes modulation in the setting of Severe COVID-19 infection. Twelve patients were recruited. Inclusion criteria were > 18 years age, confirmed COVID-19, acute respiratory distress syndrome requiring mechanical support and hypotension requiring vasopressor support. Primary end point was vasopressor requirements (expressed as epinephrine dose equivalents) and principle secondary endpoints related to safety, ability to deliver the therapy and markers of inflammation assessed over five days after treatment initiation. LMOD treatment appeared safe, defined by hemodynamic stability and no evidence of white cell number depletion from blood. We demonstrated a significant decrease in vasopressor doses (-37%, p = 0.02) in patients receiving LMOD therapy (despite these patients having to tolerate an additional extracorporeal intermittent therapy). Vasopressor requirements unchanged/increasing in control group (+ 10%, p = 0.48). Although much about the use of this therapy in the setting of severe COVID-19 infection remains to be defined (e.g. optimal dose and duration), this preliminary study supports the further evaluation of this novel extracorporeal approach.
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Affiliation(s)
- Sandrine Lemoine
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Jarrin Penny
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Robarts Research Institute, Western University, London, Canada
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Division of Nephrology, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Douglas D Fraser
- Lawson Health Research Institute, London, ON, Canada
- Departments of Pediatrics, Clinical Neurological Sciences and Physiology and Pharmacology, Western University, London, ON, Canada
| | - Fabio R Salerno
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Robarts Research Institute, Western University, London, Canada
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Justin Dorie
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Tanya Tamasi
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Robert Arntfield
- Lawson Health Research Institute, London, ON, Canada
- Departments of Critical Care Medicine, Victoria Hospital, London, Canada
| | - Andrew House
- Division of Nephrology, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Marat Slessarev
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada
- Lawson Health Research Institute, London, ON, Canada
- Departments of Critical Care Medicine, Victoria Hospital, London, Canada
| | - Christopher W McIntyre
- The Lilibeth Caberto Kidney Clinical Research Unit (KCRU), Kidney Clinical Research Unit Room ELL-101, London Health Sciences, University of Western Ontario, Centre 800 Commissioners Rd E, London, ON, N6A5W9, Canada.
- Robarts Research Institute, Western University, London, Canada.
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
- Division of Nephrology, Schulich School of Medicine & Dentistry, Western Ontario, London, Canada.
- Lawson Health Research Institute, London, ON, Canada.
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Reis T, Colares VS, Rocha E, Younes-Ibrahim M, de Lima EQ, Andrade LDC, Ponce D, Suassuna JHR, Yu L. Acute kidney injury and renal replacement therapy: terminology standardization. J Bras Nefrol 2022; 44:434-442. [PMID: 35579341 PMCID: PMC9518623 DOI: 10.1590/2175-8239-jbn-2021-0284en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.
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Affiliation(s)
- Thiago Reis
- Universidade de Brasília, Laboratório de Farmacologia Molecular, Brasília, DF, Brasil
- Hospital DF Star, Clínica de Doenças Renais de Brasília, Brasília, DF, Brasil
| | | | - Eduardo Rocha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Mauricio Younes-Ibrahim
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brasil
| | | | | | - Daniela Ponce
- Universidade Estadual de São Paulo, Departamento de Clínica Médica, São Paulo, SP, Brasil
| | - José H. Rocco Suassuna
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brasil
| | - Luis Yu
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP
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Reis T, Colares VS, Rocha E, Younes-Ibrahim M, Lima EQD, Andrade LDC, Ponce D, Suassuna JHR, Yu L. Injúria renal aguda e métodos de suporte: padronização da nomenclatura. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0284pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.
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Affiliation(s)
- Thiago Reis
- Universidade de Brasília, Brasil; Hospital DF Star, Brasil
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