Hemoadsorption: consensus report of the 30th Acute Disease Quality Initiative workgroup

医学 重症监护医学 体外 临床试验 工作组 外科 内科学 计算机网络 计算机科学
作者
Rinaldo Bellomo,Ghada Ankawi,Sean M. Bagshaw,Ian Baldwin,Rajit K. Basu,Gabriella Bottari,Vincenzo Cantaluppi,William R. Clark,Silvia De Rosa,Lui G. Forni,Dana Y. Fuhrman,Stuart L. Goldstein,Hernando Gómez,Faeq Husain‐Syed,Michael Joannidis,Kianoush Kashani,Anna Lorenzin,Ravindra L. Mehta,Patrick Murray,Ragi Murugan
出处
期刊:Nephrology Dialysis Transplantation [Oxford University Press]
卷期号:39 (12): 1945-1964 被引量:17
标识
DOI:10.1093/ndt/gfae089
摘要

ABSTRACT Adsorption-based extracorporeal therapies have been subject to technical developments and clinical application for close to five decades. More recently, new technological developments in membrane and sorbent manipulation have made it possible to deliver more biocompatible extracorporeal adsorption therapies to patients with a variety of conditions. There are several key rationales based on physicochemical principles and clinical considerations that justify the application and investigation of such therapies as evidenced by multiple ex vivo, experimental and clinical observations. Accordingly, unspecific adsorptive extracorporeal therapies have now been applied to the treatment of a wide array of conditions from poisoning to drug overdoses, to inflammatory states and sepsis, and acute or chronic liver and kidney failure. In response to the rapidly expanding knowledge base and increased clinical evidence, we convened an Acute Disease Quality Initiative consensus conference dedicated to such treatment. The data show that hemoadsorption has clinically acceptable short-term biocompatibility and safety, technical feasibility and experimental demonstration of specified target molecule removal. Pilot studies demonstrate potentially beneficial effects on physiology and larger studies of endotoxin-based hemoadsorption have identified possible target phenotypes for larger randomized controlled trials. Moreover, in a variety of endogenous and exogenous intoxications, removal of target molecules has been confirmed in vivo. However, some studies have raised concerns about harm, or failed to deliver benefits. Thus, despite many achievements, modern hemoadsorption remains a novel and experimental intervention with limited data, and a large research agenda.
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