Standardization of Nomenclature for the Mechanisms and Materials Utilized for Extracorporeal Blood Purification

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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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Über die von der molekularkinetischen Theorie der Wärme geforderte Bewegung von in ruhenden Flüssigkeiten suspendierten Teilchen

A Einstein (1905)

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Extracorporeal Blood Purification Therapies for Sepsis

Céline Monard, Thomas Rimmelé, Claudio Ronco (2019)

Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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The Rise of Expanded Hemodialysis.

Claudio Ronco (2017)

The low water permeability feature of original cellulosic membranes was considered an advantage in the absence of dialysis equipment that are capable of controlling water removal. The advent of ultrafiltration control systems led to the development and use of high-flux (HF) membranes that allowed improved middle molecule removal including β-2 microglobulin. Further advances in technology allowed better control over the structure and permeability of membranes. Different polymers and improved spinning modalities led to significant advances in solute removal and hemocompatibility. Inner surface modification produced a reduction in membrane thrombogenicity and protein-membrane interaction with a less tendency to fouling and permeability decay. Further evolution in technology led to the development of a new class of membranes referred to as protein-leaking membranes or super-flux or high cutoff (HCO). These membranes are more permeable than conventional HF membranes and allow some passage of proteins, including albumin. The rationale for these membranes is the need for increased clearance of low molecular weight proteins and protein-bound solutes. However, albumin loss in protein-leaking HCO membranes represents a limitation whose effect in patients is still controversial. The last evolution in the field of membranes is the development of a new class defined as "high retention onset" (HRO) due to the peculiar high sieving value in the middle to high molecular weight range. The introduction of HRO membranes in the clinical routine has enabled the development of a new concept therapy called "expanded hemodialysis." Its simple set up and application offer the possibility to use it even in patients with suboptimal vascular access or even with an indwelling catheter. The system does not require particular hardware or unusual nursing skill. The quality of dialysis fluid is, however, mandatory to ensure a safe conduction of the dialysis session. This new therapy is likely to modify the outcome of end-stage kidney disease patients, thanks to the enhanced removal of molecules traditionally retained by current dialysis techniques.

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Author and article information

Journal

Journal ID (publisher-id): BPU

Journal ID (nlm-ta): Blood Purif

Journal ID (doi): 10.1159/issn.0253-5068

Title: Blood Purification

Abbreviated Title: Blood Purif

Publisher: S. Karger AG

ISSN (Print): 0253-5068

ISSN (Electronic): 1421-9735

Publication date Subscription-year: 2024

Publication date (Print): April 2024

Publication date (Electronic): 13 September 2023

Volume: 53

Issue: 5

Pages: 329-342

Affiliations

[a ]Department of Nephrology and Kidney Transplantation, Fenix Group, São Paulo, Brazil

[b ]Laboratory of Molecular Pharmacology, University of Brasília, Brasília, Brazil

[c ]Division of Nephrology, Syrian-Lebanese Hospital, São Paulo, Brazil

[d ]International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy

[e ]Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy

[f ]Department of Medicine (DIMED), Università degli Studi di Padova, Padua, Italy

[g ]Section of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA

[h ]Davidson School of Chemical Engineering, Purdue University College of Engineering, West Lafayette, Indiana, USA

[i ]Indiana University School of Medicine, Indianapolis, Indiana, USA

[j ]Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy

[k ]Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS, Trento, Italy

[l ]Department of Critical Care, Royal Surrey Hospital Foundation Trust, Guildford, UK

[m ]Faculty of Health Sciences, University of Surrey, Guildford, UK

[n ]Department of Health Sciences, Section of Anesthesia, Intensive Care and Pain Medicine, University of Florence, Florence, Italy

[o ]Pediatric Intensive Care Unit, Meyer Children's Hospital, IRCCS, Florence, Italy

[p ]Department of Anesthesia and Intensive Care, Section of Pain Therapy and Palliative Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy

[q ]Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

[r ]Department of Medicine, University of California San Diego, San Diego, California, USA

[s ]Department of Medicine, University of Virginia Health, Charlottesville, Virginia, USA

Author notes

*Thiago Reis, thiagoreisnefro@gmail.com

Article

Publisher ID: 533330 Other ID: Blood Purif 2024;53:329–342

DOI: 10.1159/000533330

PubMed ID: 37703868

SO-VID: edc5bcc3-1aba-491d-ba42-ac7291b25a16

History

Date received : 15 May 2023

Date accepted : 28 June 2023

Page count

Figures: 6, Tables: 3, Pages: 14

Funding

This consensus conference was kindly supported by unrestricted educational grants from Ashahi, Baxter, Bioporto, Fresenius Medical Care, Jafron, MEDICA, Nipro, Spectral, and Toray.

Standardization of Nomenclature for the Mechanisms and Materials Utilized for Extracorporeal Blood Purification

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Most cited references 68

Über die von der molekularkinetischen Theorie der Wärme geforderte Bewegung von in ruhenden Flüssigkeiten suspendierten Teilchen

Extracorporeal Blood Purification Therapies for Sepsis

The Rise of Expanded Hemodialysis.

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