Initiation timing of blood purification therapy in sepsis_West China Medical Journal

Authors：

YANG Yingying , ZHANG Ling ,  FU Ping

Department of Nephrology / Kidney Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FU Ping, Email: fupinghx@163.com

Keywords：

Sepsis; acute kidney injury; blood purification therapy

DOI：

10.7507/1002-0179.202206022

Video：

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Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.

Citation： YANG Yingying, ZHANG Ling, FU Ping. Initiation timing of blood purification therapy in sepsis. West China Medical Journal, 2022, 37(7): 961-965. doi: 10.7507/1002-0179.202206022 Copy

1.	Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med, 2013, 369(9): 840-851.
2.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
3.	Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
4.	Bagshaw SM, Uchino S, Bellomo R, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol, 2007, 2(3): 431-439.
5.	Bagshaw SM, George C, Bellomo R, et al. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care, 2008, 12(2): R47.
6.	Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med, 2015, 41(8): 1411-1423.
7.	Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA, 2005, 294(7): 813-818.
8.	Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults. Clin J Am Soc Nephrol, 2015, 10(9): 1510-1518.
9.	Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care, 2012, 27(6): 743.e9-e18.
10.	Chon GR, Chang JW, Huh JW, et al. A comparison of the time from sepsis to inception of continuous renal replacement therapy versus RIFLE criteria in patients with septic acute kidney injury. Shock, 2012, 38(1): 30-36.
11.	Pérez-Fernández X, Sabater-Riera J, Sileanu FE, et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. J Crit Care, 2017, 40: 154-160.
12.	Park JY, An JN, Jhee JH, et al. Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study. Crit Care, 2016, 20(1): 260.
13.	Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
14.	Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA, 2016, 315(20): 2190-2199.
15.	STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med, 2020, 383(3): 240-251.
16.	Gaudry S, Hajage D, Benichou N, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet, 2020, 395(10235): 1506-1515.
17.	Kellum JA, Sileanu FE, Murugan R, et al. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol, 2015, 26(9): 2231-2238.
18.	Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012(Suppl 2): 1-138.
19.	Harris SK, Lewington AJ, Harrison DA, et al. Relationship between patients’ outcomes and the changes in serum creatinine and urine output and RIFLE classification in a large critical care cohort database. Kidney Int, 2015, 88(2): 369-377.
20.	Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 8(4): R204-R212.
21.	Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int, 2009, 76(4): 422-427.
22.	Woodward CW, Lambert J, Ortiz-Soriano V, et al. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit Care Med, 2019, 47(9): e753-e760.
23.	Dellepiane S, Marengo M, Cantaluppi V. Detrimental cross-talk between sepsis and acute kidney injury: new pathogenic mechanisms, early biomarkers and targeted therapies. Crit Care, 2016, 20: 61.
24.	Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs, 2003, 27(9): 792-801.
25.	Honoré PM, Matson JR. Extracorporeal removal for sepsis: acting at the tissue level-the beginning of a new era for this treatment modality in septic shock. Crit Care Med, 2004, 32(3): 896-897.
26.	Peng Z, Singbartl K, Simon P, et al. Blood purification in sepsis: a new paradigm. Contrib Nephrol, 2010, 165: 322-328.
27.	Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Crit Care, 2011, 15(1): 205.
28.	Rimmelé T, Kellum JA. High-volume hemofiltration in the intensive care unit: a blood purification therapy. Anesthesiology, 2012, 116(6): 1377-1387.
29.	Joannes-Boyau O, Honoré PM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med, 2013, 39(9): 1535-1546.
30.	Morgera S, Rocktäschel J, Haase M, et al. Intermittent high permeability hemofiltration in septic patients with acute renal failure. Intensive Care Med, 2003, 29(11): 1989-1995.
31.	Atan R, Peck L, Prowle J, et al. A double-blind randomized controlled trial of high cutoff versus standard hemofiltration in critically ill patients with acute kidney injury. Crit Care Med, 2018, 46(10): e988-e994.
32.	Cruz DN, Antonelli M, Fumagalli R, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, 301(23): 2445-2452.
33.	Payen DM, Guilhot J, Launey Y, et al. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med, 2015, 41(6): 975-984.
34.	Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin b hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: the EUPHRATES randomized clinical trial. JAMA, 2018, 320(14): 1455-1463.
35.	Peng ZY, Carter MJ, Kellum JA. Effects of hemoadsorption on cytokine removal and short-term survival in septic rats. Crit Care Med, 2008, 36(5): 1573-1577.
36.	Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp, 2018, 6(1): 12.
37.	Huang Z, Wang SR, Su W, et al. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial, 2010, 14(6): 596-602.
38.	Kaçar CK, Uzundere O, Kandemir D, et al. 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. Blood Purif, 2020, 49(4): 448-456.
39.	Berlot G, Agbedjro A, Tomasini A, et al. Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption. Blood Purif, 2014, 37(2): 146-151.
40.	Livigni S, Bertolini G, Rossi C, et al. Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open, 2014, 4(1): e003536.
41.	Pickkers P, Vassiliou T, Liguts V, et al. Sepsis management with a blood purification membrane: European experience. Blood Purif, 2019, 47(Suppl 3): 1-9.
42.	Schwindenhammer V, Girardot T, Chaulier K, et al. oXiris^® use in septic shock: experience of two french centres. Blood Purif, 2019, 47(Suppl 3): 1-7.
43.	Turani F, Barchetta R, Falco M, et al. Continuous renal replacement therapy with the adsorbing filter oXiris in septic patients: a case series. Blood Purif, 2019, 47(Suppl 3): 1-5.
44.	Guan M, Wang H, Tang X, et al. Continuous renal replacement therapy with adsorbing filter oxiris in acute kidney injury with septic shock: a retrospective observational study. Front Med (Lausanne), 2022, 9: 789623.
45.	Payen D, Mateo J, Cavaillon JM, et al. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial. Crit Care Med, 2009, 37(3): 803-810.
46.	Zhang L, Feng Y, Fu P. Blood purification for sepsis: an overview. Precis Clin Med, 2021, 4(1): 45-55.

1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med, 2013, 369(9): 840-851.
2. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA, 2016, 315(8): 801-810.
3. Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet, 2020, 395(10219): 200-211.
4. Bagshaw SM, Uchino S, Bellomo R, et al. Septic acute kidney injury in critically ill patients: clinical characteristics and outcomes. Clin J Am Soc Nephrol, 2007, 2(3): 431-439.
5. Bagshaw SM, George C, Bellomo R, et al. Early acute kidney injury and sepsis: a multicentre evaluation. Crit Care, 2008, 12(2): R47.
6. Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med, 2015, 41(8): 1411-1423.
7. Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA, 2005, 294(7): 813-818.
8. Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults. Clin J Am Soc Nephrol, 2015, 10(9): 1510-1518.
9. Oh HJ, Shin DH, Lee MJ, et al. Early initiation of continuous renal replacement therapy improves patient survival in severe progressive septic acute kidney injury. J Crit Care, 2012, 27(6): 743.e9-e18.
10. Chon GR, Chang JW, Huh JW, et al. A comparison of the time from sepsis to inception of continuous renal replacement therapy versus RIFLE criteria in patients with septic acute kidney injury. Shock, 2012, 38(1): 30-36.
11. Pérez-Fernández X, Sabater-Riera J, Sileanu FE, et al. Clinical variables associated with poor outcome from sepsis-associated acute kidney injury and the relationship with timing of initiation of renal replacement therapy. J Crit Care, 2017, 40: 154-160.
12. Park JY, An JN, Jhee JH, et al. Early initiation of continuous renal replacement therapy improves survival of elderly patients with acute kidney injury: a multicenter prospective cohort study. Crit Care, 2016, 20(1): 260.
13. Gaudry S, Hajage D, Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med, 2016, 375(2): 122-133.
14. Zarbock A, Kellum JA, Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial. JAMA, 2016, 315(20): 2190-2199.
15. STARRT-AKI Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group, et al. Timing of initiation of renal-replacement therapy in acute kidney injury. N Engl J Med, 2020, 383(3): 240-251.
16. Gaudry S, Hajage D, Benichou N, et al. Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials. Lancet, 2020, 395(10235): 1506-1515.
17. Kellum JA, Sileanu FE, Murugan R, et al. Classifying AKI by urine output versus serum creatinine level. J Am Soc Nephrol, 2015, 26(9): 2231-2238.
18. Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int, 2012(Suppl 2): 1-138.
19. Harris SK, Lewington AJ, Harrison DA, et al. Relationship between patients’ outcomes and the changes in serum creatinine and urine output and RIFLE classification in a large critical care cohort database. Kidney Int, 2015, 88(2): 369-377.
20. Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care, 2004, 8(4): R204-R212.
21. Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int, 2009, 76(4): 422-427.
22. Woodward CW, Lambert J, Ortiz-Soriano V, et al. Fluid overload associates with major adverse kidney events in critically ill patients with acute kidney injury requiring continuous renal replacement therapy. Crit Care Med, 2019, 47(9): e753-e760.
23. Dellepiane S, Marengo M, Cantaluppi V. Detrimental cross-talk between sepsis and acute kidney injury: new pathogenic mechanisms, early biomarkers and targeted therapies. Crit Care, 2016, 20: 61.
24. Ronco C, Tetta C, Mariano F, et al. Interpreting the mechanisms of continuous renal replacement therapy in sepsis: the peak concentration hypothesis. Artif Organs, 2003, 27(9): 792-801.
25. Honoré PM, Matson JR. Extracorporeal removal for sepsis: acting at the tissue level-the beginning of a new era for this treatment modality in septic shock. Crit Care Med, 2004, 32(3): 896-897.
26. Peng Z, Singbartl K, Simon P, et al. Blood purification in sepsis: a new paradigm. Contrib Nephrol, 2010, 165: 322-328.
27. Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Crit Care, 2011, 15(1): 205.
28. Rimmelé T, Kellum JA. High-volume hemofiltration in the intensive care unit: a blood purification therapy. Anesthesiology, 2012, 116(6): 1377-1387.
29. Joannes-Boyau O, Honoré PM, Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial. Intensive Care Med, 2013, 39(9): 1535-1546.
30. Morgera S, Rocktäschel J, Haase M, et al. Intermittent high permeability hemofiltration in septic patients with acute renal failure. Intensive Care Med, 2003, 29(11): 1989-1995.
31. Atan R, Peck L, Prowle J, et al. A double-blind randomized controlled trial of high cutoff versus standard hemofiltration in critically ill patients with acute kidney injury. Crit Care Med, 2018, 46(10): e988-e994.
32. Cruz DN, Antonelli M, Fumagalli R, et al. Early use of polymyxin B hemoperfusion in abdominal septic shock: the EUPHAS randomized controlled trial. JAMA, 2009, 301(23): 2445-2452.
33. Payen DM, Guilhot J, Launey Y, et al. Early use of polymyxin B hemoperfusion in patients with septic shock due to peritonitis: a multicenter randomized control trial. Intensive Care Med, 2015, 41(6): 975-984.
34. Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin b hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: the EUPHRATES randomized clinical trial. JAMA, 2018, 320(14): 1455-1463.
35. Peng ZY, Carter MJ, Kellum JA. Effects of hemoadsorption on cytokine removal and short-term survival in septic rats. Crit Care Med, 2008, 36(5): 1573-1577.
36. Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices. Intensive Care Med Exp, 2018, 6(1): 12.
37. Huang Z, Wang SR, Su W, et al. Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column. Ther Apher Dial, 2010, 14(6): 596-602.
38. Kaçar CK, Uzundere O, Kandemir D, et al. 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. Blood Purif, 2020, 49(4): 448-456.
39. Berlot G, Agbedjro A, Tomasini A, et al. Effects of the volume of processed plasma on the outcome, arterial pressure and blood procalcitonin levels in patients with severe sepsis and septic shock treated with coupled plasma filtration and adsorption. Blood Purif, 2014, 37(2): 146-151.
40. Livigni S, Bertolini G, Rossi C, et al. Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open, 2014, 4(1): e003536.
41. Pickkers P, Vassiliou T, Liguts V, et al. Sepsis management with a blood purification membrane: European experience. Blood Purif, 2019, 47(Suppl 3): 1-9.
42. Schwindenhammer V, Girardot T, Chaulier K, et al. oXiris^® use in septic shock: experience of two french centres. Blood Purif, 2019, 47(Suppl 3): 1-7.
43. Turani F, Barchetta R, Falco M, et al. Continuous renal replacement therapy with the adsorbing filter oXiris in septic patients: a case series. Blood Purif, 2019, 47(Suppl 3): 1-5.
44. Guan M, Wang H, Tang X, et al. Continuous renal replacement therapy with adsorbing filter oxiris in acute kidney injury with septic shock: a retrospective observational study. Front Med (Lausanne), 2022, 9: 789623.
45. Payen D, Mateo J, Cavaillon JM, et al. Impact of continuous venovenous hemofiltration on organ failure during the early phase of severe sepsis: a randomized controlled trial. Crit Care Med, 2009, 37(3): 803-810.
46. Zhang L, Feng Y, Fu P. Blood purification for sepsis: an overview. Precis Clin Med, 2021, 4(1): 45-55.

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