Continuous veno-venous hemofiltration yields better renal outcomes than intermittent hemodialysis among traumatic intracranial hemorrhage patients with acute kidney injury: A nationwide population-based retrospective study in Taiwan

Can Artificial Intelligence Assist in Delivering Continuous Renal Replacement Therapy?

Continuous renal replacement therapy (CRRT) is widely utilized to support critically ill patients with acute kidney injury. Artificial intelligence (AI) has the potential to enhance CRRT delivery, but evidence is limited. We reviewed existing literature on the utilization of AI in CRRT with the objective of identifying current gaps in evidence and research considerations. We conducted a scoping review focusing on the development or use of AI-based tools in patients receiving CRRT. Ten papers were identified; 6 of 10 (60%) published in 2021, and 6 of 10 (60%) focused on machine learning models to augment CRRT delivery. All innovations were in the design/early validation phase of development. Primary research interests focused on early indicators of CRRT need, prognostication of mortality and kidney recovery, and identification of risk factors for mortality. Secondary research priorities included dynamic CRRT monitoring, predicting CRRT-related complications, and automated data pooling for point-of-care analysis. Literature gaps included prospective validation and implementation, biases ascertainment, and evaluation of AI-generated health care disparities. Research on AI applications to enhance CRRT delivery has grown exponentially in the last years, but the field remains premature. There is a need to evaluate how these applications could enhance bedside decision-making capacity and assist structure and processes of CRRT delivery.

Continuous Renal Replacement Therapy in Acute Brain Injury

Acute brain injury is the sudden and reversible loss of brain self regulation capacity as a disruption of the blood-brain barrier that conditions metabolic and inflammatory disorders that can exacerbate acute kidney injury in a critical setting; specifically it has been described that the alterations of the internal environment that come from the severity of the acute kidney injury increases the risk of endocranial hypertension and cerebral edema; in this context, injuries should be identified and treated in a timely manner with a comprehensive approach. Continuous renal replacement therapy is an extracorporeal purification technique that has been gaining ground in the management of acute kidney injury in critically ill patients. Within its modalities, continuous venous venous hemofiltration is described as the therapy of choice in patients with acute brain injury due to its advantages in maintaining hemodynamic stability and reducing the risk of cerebral edema. Optimal control of variables such as timing to start renal replacement therapy, the prescribed dose, the composition of the replacement fluid and the anticoagulation of the extracorporeal circuit will have a significant impact on the evolution of the neurocritical patient with acute kidney injury. There are limited studies evaluating the role of hemofiltration in this context.

Effects of two blood purification treatments combined with immunosuppressants on GM-CSF and CXCL16 levels in patients with lupus nephritis

OBJECTIVES

This study aimed to investigate the therapeutic effects of two different blood purification treatments combined with immunosuppressants on patients with lupus nephritis (LN) and their effects affecting granulocyte-macrophage colony-stimulating factor (GM-CSF) and CXC chemokine ligand-16 (CXCL16) levels.

METHODS

Ninety patients with LN admitted to our hospital were enrolled and randomly assigned into groups A and B. Group A was treated with continuous veno-venous hemofiltration (CVVH) combined with conventional medical treatment (CMT, n = 40, including 23 females and 17 males), whereas group B was treated with intermittent hemodialysis combined with conventional medical treatment (n = 50, including 35 females and 15 males). Both groups received prednisone and cyclophosphamide.

RESULTS

GM-CSF and CXCL16 levels in the two groups were significantly reduced after treatment (P < 0.05); and GM-CSF level in group A was significantly lower than that in group B (P < 0.05, -1.261 to -0.8395), and CXCL16 level in group A was significantly lower than that in group B (P < 0.05, -0.5745 to -0.4355). There was no significant difference in general data between the two groups (P > 0.05). After treatment, the SLEDAI scores were significantly decreased in both groups, and were significantly lower in group A than in group B (P < 0.05, -1.816 to -0.1241).

CONCLUSION

CVVH combined with conventional medical treatment is more effective than intermittent hemodialysis combined with conventional medical treatment, and is easier to remove GM-CSF and CXCL16.

Complement Inhibition Therapy and Dialytic Strategies in Paroxysmal Nocturnal Hemoglobinuria: The Nephrologist's Opinion

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disease that presents an estimated incidence of 1.3 cases per million per year, with a prevalence of 15.9 cases per million. It is characterized by hemolysis, bone marrow dysfunction with peripheral blood cytopenia, hypercoagulability, thrombosis, renal impairment and arterial and pulmonary hypertension. Hemolysis and subsequent hemosiderin accumulation in tubular epithelium cells induce tubular atrophy and interstitial fibrosis. The origin of PNH is the somatic mutation in the X-linked phosphatidylinositol glycan class A (PIG-A) gene located on Xp22: this condition leads to the production of clonal blood cells with a deficiency in those surface proteins that protect against the lytic action of the activated complement system. Despite the increased knowledge of this syndrome, therapies for PNH were still only experimental and symptomatic, until the introduction of the C5 complement blockade agent Eculizumab. A second generation of anti-complement agents is currently under investigation, representing future promising therapeutic strategies for patients affected by PNH. In the case of chronic hemolysis and renal iron deposition, a multidisciplinary approach should be considered to avoid or treat acute tubular injury or acute kidney injury (AKI). New promising perspectives derive from complement inhibitors and iron chelators, as well as more invasive treatments such as immunoadsorption or the use of dedicated hemodialysis filters in the presence of AKI.