Adsorption in Extracorporeal Therapies

Hemoadsorption: A New Frontier in Blood Purification

Limitations imposed by current dialysis techniques due to membrane permeability and inadequate clearance of large middle molecules and protein-bound solutes require new methods of blood purification. Such opportunity is offered by new sorbent materials and new extracorporeal hemoadsorption techniques. These new options will represent a new frontier in the area of blood purification for patients with acute and chronic kidney diseases, but also for patients with critical illness and requirement of multiple organ support. While the history of sorbents started almost two centuries ago, only recently synthetic porous polymers have been applied for effective blood purification purposes [1].

Highly biocompatible new sorbent materials allowed a progressive expansion of the clinical application of hemoadsorption [2]. The analysis of the molecular structure of sorbents, as well as the study of the chemical-physical mechanisms involved in the process of adsorption, are fascinating and not completely elucidated. Initial reports of application in chronic patients with pruritus and other solute-related symptoms (especially in the field of liver failure) have provided encouraging results. At the same time, clinical applications of sorbents in critical illness such as sepsis, acute kidney injury, cytokine release syndrome, burns, and trauma, have provided a remarkable number of hypothesis-generating papers and studies that require an in-depth evaluation [3].

While the rationale is evident, larger prospective studies are required to corroborate initial results. We need to identify meaningful target molecules and to understand what conditions trigger the application of hemoadsorption. We need to define the timing of application, the duration of the session. We need to elucidate the adequate dose of hemoadsorption and the correct criteria for prescription while clarifying the potential side effects. This first collection of papers in a special focus issue of Blood Purification is just the beginning of a process of continuous search for new evidence and new clinical data that will find in our journal the place for presenting new information and new discoveries to the scientific community. Somehow, we are today with sorbents where we were 40 years ago with dialysis membranes. We need to answer the question for hemoadsorption that we answered in the last four decades for hemodialysis and CRRT. The pathway towards the future of blood purification has begun and we are looking forward to evaluate and publish more papers to design the scientific evidence for the rising era of hemoadsorption.

Fig. 1. Description of the main mass separation processes in extracorporeal techniques for blood purification: diffusion, convection, adsorption.

References

1. Ronco C, Bordoni V, Levin NW. Contrib Nephrol 2002;137:158-164.
2. Ankawi G, Fan W, et al. Blood Purif. 2019;47(1-3):94-100.
3. Monard C, Rimmelé T, Ronco C. Blood Purif. 2019;47 Suppl 3:1-14.

Special Topic Articles in Blood Purification

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  Convalescent Blood: Current Perspective on the Efficacy of a Legacy Approach in COVID-19 Treatment
  Sheervalilou R. · Shirvaliloo M. · Sargazi S. · Bahari S. · Saravani R. · Shahraki J. · Shirvalilou S. · Shahraki O. · Nazarlou Z. · Shams Z. · Ghaznavi H.
  Blood Purif 2022;51:1–14 (DOI:10.1159/000513164)

   

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  The Efficacy of Resin Hemoperfusion Cartridge on Inflammatory Responses during Adult Cardiopulmonary Bypass
  He Z. · Lu H. · Jian X. · Li G. · Xiao D. · Meng Q. · Chen J. · Zhou C.
  Blood Purif 2022;51:31–37 (DOI:10.1159/000514149)

   

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  Endotoxin Adsorbent Therapy in Severe COVID-19 Pneumonia
  Peerapornratana S. · Sirivongrangson P. · Tungsanga S. · Tiankanon K. · Kulvichit W. · Putcharoen O. · Kellum J.A. · Srisawat N.
  Blood Purif 2022;51:47–54 (DOI:10.1159/000515628)

   

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  Efficacy, Safety, and Calcium Balance of an Accelerated Citrate Anticoagulated Membrane-Based Plasma Exchange Algorithm
  Halpin M.R. · Chen B. · Singer R.F.
  Blood Purif 2022;51:70–74 (DOI:10.1159/000515827)

   

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  Subarachnoid Hemorrhage and Extracorporeal Blood Purification with HA-380 and High-Volume Hemofiltration: A New Therapeutic Challenge at the Neurocritical Care Unit? A Case Report
  Ramírez-Guerrero G. · Oliva Alarcón R. · Villagrán Cortés F. · Torres Cifuentes V. · Baghetti Hernández R. · Flores Fernandez P. · Godoy Tello C. · Torres Moyano F. · Lucero Córdova C. · Rojas Doll S. · Garay Coloma O.
  Blood Purif 2022;51:87–90 (DOI:10.1159/000514908)

   

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  Extracorporeal Blood Purification in Moderate and Severe COVID-19 Patients: A Prospective Cohort Study
  Rosalia R.A. · Ugurov P. · Neziri D. · Despotovska S. · Kostoska E. · Veljanovska-Kiridjievska L. · Kuzmanov D. · Trifunovski A. · Popevski D. · Villa G. · Mitrev Z.
  Blood Purif 2022;51:233-242 (DOI:10.1159/000515627)

   

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  Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion for Micro-Preemie Infants: Is Extended Duration Better than Early Start?
  Nishizaki N. · Obinata K. · Shimizu T.
  Blood Purif 2022;51:472-474 (DOI:10.1159/000518231)

   

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  Polymyxin B-Immobilized Fiber Column Direct Hemoperfusion for Micro-Preemie Infants with Septic Shock. Is Extended Duration Better than Early Start? Comment to the Letter to the Editor of Nishizaki and Colleagues
  Mitaka C. · Iba T. · Ronco C.
  Blood Purif 2022;51:475-476 (DOI:10.1159/000518904)

   

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  Endotoxin and Cytokine Sequential Hemoadsorption in Septic Shock and Multi-Organ Failure
  Ruiz-Rodríguez J.C. · Chiscano-Camón L. · Palmada C. · Ruiz-Sanmartin A. · Pérez-Carrasco M. · Larrosa N. · González J.J. · Hernández-González M. · Ferrer R.
  Blood Purif 2022;51:630-633 (DOI:10.1159/000518229)

   

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  Combined Hemoperfusion and Continuous Veno-Venous Hemofiltration for Carbamazepine Intoxication
  Baylis S. · Costa-Pinto R. · Hodgson S. · Bellomo R. · Baldwin I.
  Blood Purif 2022;51:721-725 (DOI:10.1159/000520520)

   

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  Benefit of Hemoadsorption Therapy in Patients Suffering Sepsis-Associated Acute Kidney Injury: A Case Series
  Hakemi M.S. · Nassiri A.A. · Nobakht A. · Mardani M. · Darazam I.A. · Parsa M. · Miri M.M. · Shahrami R. · Koomleh A.A. · Entezarmahdi K. · Karimi A.
  Blood Purif 2022;51:823-830 (DOI:10.1159/000521228)

   

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  The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study
  Surasit K. · Srisawat N.
  Blood Purif 2022;51:879-888 (DOI:10.1159/000521713)

   

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  Effect of oXiris-CVVH on the Clinical Outcomes of Patients with Septic Shock: An Inverse Probability of Treatment-Weighted Analysis
  Xie J. · Xiao W. · Lin J.
  Blood Purif 2022;51:972-989 (DOI:10.1159/000524088)

   

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  Heparin 2.0: A New Approach to the Infection Crisis
  Seffer M.-T. · Cottam D. · Forni L.G. · Kielstein J.T.
  Blood Purif 2021;50:28-34 (DOI:10.1159/000508647)

   

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  Successful Treatment of Severe Digitoxin Intoxication with CytoSorb® Hemoadsorption
  Breuer T.G.K. · Quast D.R. · Wiciok S. · Labedi A. · Ellrichmann G.
  Blood Purif 2021;50:137-140 (DOI:10.1159/000510292)

   

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  Cytokine Adsorption to Polymyxin B-Immobilized Fiber: An in vitro Study
  Utsunomiya T. · Mimura-Kimura Y. · Yamamoto T. · Aoe K. · Oishi K. · Kamei H. · Matsunaga K. · Yano M. · Mimura Y.
  Blood Purif 2021;50:230-237 (DOI:10.1159/000510290)

   

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  Early Hemoperfusion for Cytokine Removal May Contribute to Prevention of Intubation in Patients Infected with COVID-19
  Esmaeili Vardanjani A. · Ronco C. · Rafiei H. · Golitaleb M. · Pishvaei M.H. · Mohammadi M.
  Blood Purif 2021;50:257-260 (DOI:10.1159/000509107)

   

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  Coronavirus Disease 19 Pandemic and Extracorporeal Therapies in Intensive Care: “Bis Peccare in Bello Non Licet”
  Maoujoud O. · Asserraji M. · Belarbi M. · Zemraoui N.
  Blood Purif 2021;50:261-262 (DOI:10.1159/000507603)

   

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  Effects of Hemoadsorption with Cytosorb during Severe Rhabdomyolysis: Reply to the Letter to the Editor of Daum and Colleagues
  Dilken O. · Ince C. · de Geus H.R.H.
  Blood Purif 2021;50:273-274 (DOI:10.1159/000509898)

   

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  Effect of Extracorporeal Blood Purification on Mortality in Sepsis: A Meta-Analysis and Trial Sequential Analysis
  Snow T.A.C. · Littlewood S. · Corredor C. · Singer M. · Arulkumaran N.
  Blood Purif 2021;50:462-472 (DOI:10.1159/000510982)

   

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  Improved Survival beyond 28 Days up to 1 Year after CytoSorb Treatment for Refractory Septic Shock: A Propensity-Weighted Retrospective Survival Analysis
  Brouwer W.P. · Duran S. · Ince C.
  Blood Purif 2021;50:539-545 (DOI:10.1159/000512309)

   

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  Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan
  Fujimori K. · Tarasawa K. · Fushimi K.
  Blood Purif 2021;50:560-565 (DOI:10.1159/000513213)

   

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  Hemoperfusion with CytoSorb as Adjuvant Therapy in Critically Ill Patients with SARS-CoV2 Pneumonia
  Rampino T. · Gregorini M. · Perotti L. · Ferrari F. · Pattonieri E.F. · Grignano M.A. · Valente M. · Garrone A. · Islam T. · Libetta C. · Sepe V. · Albertini R. · Bruno R. · Belliato M.
  Blood Purif 2021;50:566-571 (DOI:10.1159/000511725)

   

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  Plasmapheresis for the Treatment of Acute Pancreatitis due to Severe Hypertriglyceridemia
  Ruiz-Rodríguez J.C. · Chiscano-Camón L.S. · Palmada C. · Pons V. · Ferrer R.
  Blood Purif 2021;50:572-574 (DOI:10.1159/000510647)

   

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  Early Cytokine Removal in Critical COVID-19 Patients with Extracorporeal Therapies (HA-380 plus High Volume Hemofiltration) May Prevent Progression of Acute Respiratory Distress Syndrome: Case Report
  Ramírez-Guerrero G. · Torres Cifuentes V. · Baghetti Hernández R. · Villagrán Cortés F. · Rojas Doll S. · Oliva Alarcón R. · Lucero Córdova C. · Flores Fernandez P. · Garay Coloma O.
  Blood Purif 2021;50:575-577 (DOI:10.1159/000512982)

   

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  Efficiency of Double Plasma Molecular Absorption System on the Acute Severe Cholestatic Hepatitis
  Wu M. · Zhang H. · Huang Y. · Wu W. · Huang J. · Yan D.
  Blood Purif 2021;50:876-882 (DOI:10.1159/000513161)

   

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  Pumpless Extracorporeal Hemadsorption Technique: A New Method for Early Cytokine Elimination?
  Fiedler M.O. · Reyher C. · Kalenka A. · Rolfes C. · Lotz C. · Muellenbach R.M.
  Blood Purif 2021;50:968-970 (DOI:10.1159/000512983)

   

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  The Seraph®-100 Microbind Affinity Blood Filter Does Not Affect Vancomycin, Tacrolimus, and Mycophenolic Acid Plasma Concentrations
  de Geus H.R.H. · Smeets T. · Hoek R.A.S. · Endeman H. · Hunfeld N.
  Blood Purif 2021;50:971-975 (DOI:10.1159/000514523)

   

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  COVID-19: Hyperinflammatory Syndrome and Hemoadsorption with CytoSorb
  Masmouei B. · Harorani M. · Bazrafshan M.-R. · Karimi Z.
  Blood Purif 2021;50:976-978 (DOI:10.1159/000512199)

   

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  Efficacy of HA330 Hemoperfusion Adsorbent in Patients Followed in the Intensive Care Unit for Septic Shock and Acute Kidney Injury and Treated with Continuous Venovenous Hemodiafiltration as Renal Replacement Therapy
  Kaçar C.K. · Uzundere O. · Kandemir D. · Yektaş A.
  Blood Purif 2020;49:448-456 (DOI:10.1159/000505565)

   

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  Brief Report: A Case of Tramadol Overdose: Extracorporeal Life Support and Hemoperfusion as Life-Saving Treatment
  Ferrari F. · Carletti A. · Peroni N. · Mongodi S. · Esposito P. · Orlando A. · Mojoli F. · Ronco C. · Belliato M. · Iotti G.A.
  Blood Purif 2020;49:509-512 (DOI:10.1159/000505845)

   

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  Extracorporeal Therapies in the Treatment of Focal Segmental Glomerulosclerosis
  Raina R. · Wang J. · Sharma A. · Chakraborty R.
  Blood Purif 2020;49:513-523 (DOI:10.1159/000506277)

   

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  Immunoadsorption Combined with Membrane Filtration to Counteract Early Treatment-Refractory Antibody-Mediated Rejection
  Doberer K. · Bond G. · Kläger J. · Regele H. · Strassl R. · Reindl-Schwaighofer R. · Scheriau G. · Wahrmann M. · Kikić Z. · Faé I. · Fischer G. · Böhmig G.A. · Eskandary F.
  Blood Purif 2020;49:576-585 (DOI:10.1159/000506504)

   

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  A Promising Innovative Treatment for ST-Elevation Myocardial Infarction: The Use of C-Reactive Protein Selective Apheresis: Case Report
  Boljevic D. · Nikolic A. · Rusovic S. · Lakcevic J. · Bojic M. · Balint B.
  Blood Purif 2020;49:753-757 (DOI:10.1159/000506176)

   

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