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Reis T, Ronco C, Soranno DE, Clark W, De Rosa S, Forni LG, Lorenzin A, Ricci Z, Villa G, Kellum JA, Mehta R, Rosner MH. Standardization of Nomenclature for the Mechanisms and Materials Utilized for Extracorporeal Blood Purification. Blood Purif 2023; 53:329-342. [PMID: 37703868 DOI: 10.1159/000533330] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/28/2023] [Indexed: 09/15/2023]
Abstract
In order to develop a standardized nomenclature for the mechanisms and materials utilized during extracorporeal blood purification, a consensus expert conference was convened in November 2022. Standardized nomenclature serves as a common language for reporting research findings, new device development, and education. It is also critically important to support patient safety, allow comparisons between techniques, materials, and devices, and be essential for defining and naming innovative technologies and classifying devices for regulatory approval. The multidisciplinary conference developed detailed descriptions of the performance characteristics of devices (membranes, filters, and sorbents), solute and fluid transport mechanisms, flow parameters, and methods of treatment evaluation. In addition, nomenclature for adsorptive blood purification techniques was proposed. This report summarizes these activities and highlights the need for standardization of nomenclature in the future to harmonize research, education, and innovation in extracorporeal blood purification therapies.
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Affiliation(s)
- Thiago Reis
- Department of Nephrology and Kidney Transplantation, Fenix Group, São Paulo, Brazil
- Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil
- Division of Nephrology, Syrian-Lebanese Hospital, São Paulo, Brazil
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- Department of Medicine (DIMED), Università degli Studi di Padova, Padua, Italy
| | - Danielle E Soranno
- Section of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - William Clark
- Davidson School of Chemical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Silvia De Rosa
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy
| | - Lui G Forni
- Department of Critical Care, Royal Surrey Hospital Foundation Trust, Guildford, UK
- Faculty of Health Sciences, University of Surrey, Guildford, UK
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Zaccaria Ricci
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy
- Department of Anesthesia and Intensive Care, Section of Pain Therapy and Palliative Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ravindra Mehta
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA
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Meijers B, Vega A, Juillard L, Kawanishi H, Kirsch AH, Maduell F, Massy ZA, Mitra S, Vanholder R, Ronco C, Cozzolino M. Extracorporeal Techniques in Kidney Failure. Blood Purif 2023; 53:343-357. [PMID: 38109873 DOI: 10.1159/000533258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 12/20/2023]
Abstract
During the last decades, various strategies have been optimized to enhance clearance of a variable spectrum of retained molecules to ensure hemodynamic tolerance to fluid removal and improve long-term survival in patients affected by kidney failure. Treatment effects are the result of the interaction of individual patient characteristics with device characteristics and treatment prescription. Historically, the nephrology community aimed to provide adequate treatment, along with the best possible quality of life and outcomes. In this article, we analyzed blood purification techniques that have been developed with their different characteristics.
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Affiliation(s)
- Bjorn Meijers
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology, UZ Leuven, Leuven, Belgium
| | - Almudena Vega
- Nephrology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Laurent Juillard
- Medical School, Claude Bernard University (Lyon 1), Villeurbanne, France
- Department of Nephrology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hideki Kawanishi
- Department of Kidney Diseases and Blood Purification Therapy, Tsuchiya General Hospital, Hiroshima, Japan
| | | | - Francisco Maduell
- Department of Nephrology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ziad A Massy
- Service de Néphrologie, CHU Ambroise Paré, Assistance Publique - Hôpitaux de Paris et Université Paris-Saclay (Versailles-Saint-Quentin-en-Yvelines), Boulogne Billancourt, France
- Inserm U-1018 Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Villejuif, France
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals, Manchester, UK
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, Nephrology Section, University Hospital, Ghent, Belgium
- European Kidney Health Alliance, Brussels, Belgium
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
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Lee S, Sirich TL, Meyer TW. Improving Solute Clearances by Hemodialysis. Blood Purif 2022; 51:1-12. [PMID: 35613554 PMCID: PMC9691790 DOI: 10.1159/000524512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/19/2022]
Abstract
The adequacy of hemodialysis is now assessed by measuring the removal of the single-solute urea. The urea clearance provided by contemporary dialysis is a large fraction of the blood flow through the dialyzer and therefore cannot be increased much further. Other solutes however likely contribute more than urea to the residual uremic illness suffered by hemodialysis patients. We here review methods which could be employed to increase the clearance of nonurea solutes. We will separately consider the clearances of free low-molecular-mass solutes, free larger solutes, and protein-bound solutes. New clinical studies will be required to test the extent to which increasing the clearance on nonurea solutes with these various characteristics can improve patients' health.
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Affiliation(s)
- Seolhyun Lee
- The Department of Medicine, Stanford University, Palo Alto, California, USA
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Tammy L. Sirich
- The Department of Medicine, Stanford University, Palo Alto, California, USA
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Timothy W. Meyer
- The Department of Medicine, Stanford University, Palo Alto, California, USA
- The Department of Medicine, VA Palo Alto Healthcare System, Palo Alto, California, USA
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