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A Journal on Nephrology and Urology

Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,536

Frequency: Bi-Monthly

ISSN 0393-2249

Online ISSN 1827-1758


Minerva Urologica e Nefrologica 2004 September;56(3):215-21


Sorbents in the treatment of renal failure

Winchester J. F., Salsberg J. A.

MedaSorb Technologies, LLC Monmouth JCT, NJ, USA

Standard re­nal re­place­ment ther­a­py in ­acute re­nal fail­ure (ARF) and end-­stage re­nal dis­ease (­ESRD) is ­based on mem­brane tech­nol­o­gy. The tran­si­tion ­from nat­u­ral cel­lu­los­ic mem­branes to syn­thet­ic mem­branes has not ­been as­so­ciat­ed ­with im­prove­ment in mor­tal­ity ­rates. Modifications of di­al­y­sis ­with con­tin­u­ous ar­ter­i­ov­e­nous he­mo­fil­tra­tion and he­mo­di­a­fil­tra­tion to re­move mid­dle mo­lec­u­lar ­weight tox­ins, low mo­lec­u­lar ­weight pro­teins and pep­tides (LMWP) and cy­to­kines in­volved in in­flam­ma­tion ap­pear to ­have ­reached ­their lim­its. High ­flux di­a­lyz­ers are not ef­fi­cient at re­mov­ing ­LMWP and for ­this rea­son sor­bents to aug­ment or re­place di­al­y­sis ­have ­been ­used in clin­i­cal ­trials. Removal of ­LMWP ­such as β2-mi­cro­glob­u­lin, lep­tin, com­ple­ment fac­tor D, an­gio­ge­nin, and cy­to­kines ­such as IL-1, IL-6, IL-10, IL-18 and TNFα, ­have ­been es­tab­lished in an­i­mal mod­els of sep­sis, and in ­ESRD pa­tients us­ing sor­bents in con­junc­tion ­with ­high ­flux di­al­y­sis. Sorbent de­vic­es add­ed to he­mo­di­al­y­sis, or ­alone in in­flam­ma­to­ry ­states, are be­ing stud­ied in dis­eas­es ­which pos­sess a com­mon path­way of system­ic in­flam­ma­to­ry re­sponse syn­drome; ­these ­states are sep­sis, ARF, car­dio-pul­mo­nary by­pass, in ­brain ­dead sub­jects ­prior to ex­plan­ta­tion of do­nor or­gans and ­ESRD.

language: English


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