7. Manifestasi Klinik Toksin Uremik
• Kidney
• Kidney-heart axis
• Kidney- intestinal
mucosal barrier
axis
• Kidney-liver axis
• Kidney-brain axis
• Kidney-lung axis
• AKI, CKD
• Cardiorenal syndrome – 5 types of different
interactions between chronic dysfunctions of
the heart or kidneys which can induce acute or
chronic dysfunction of other organs
• Impaired function of key proteins of the
intestinal epithelial tight junction in uremia
• Type 1 hepatorenal syndrome Type 2
hepatorenal syndrome
• Cognitive disorders and dementia, Uremic
encephalopathy
• Increased lung vascular permeability in AKI
18. Definition of Hemoperfusion
RBC
Small molecules
Aim molecules
Hemoperfusion is a method that
uses adsorbent to adsorb
toxins, drugs and metabolites
and clear them from blood.
Aim molecules
Flow
direction
Blood
Resin
19.
20.
21. HP&HD/PE/HDF/CRRT
Blood purification
mode
Clearance range Advantage Disadvantage
HD Small molecules
Regulating water, electrolyte and acid
base balance;
Mature technology.
Low effect on removing mid-
large molecules
HF
Small-mid
molecules
Better than HD in removing fluid and
mid molecules
Complicated technology;
Higher cost;
Risk of infection.
HDF
Small-large
molecules
Combination of HD and HF
Higher cost;
Complicated operating
procedure.
CRRT
Small-large
molecules
Stable haemodynamics;
Continuous removal of toxins;
Nutrition supply when necessary.
Long time, low effect;
Coagulation and bleeding risk.
HP
Mid-large
molecules
Broad application and flexible to be
combined with other purification
modes
Unable to regulate water,
electrolyte and acid base
balance
22.
23. • Pembuangan agresif middle molekul atau low molecular weight
protein yang lebih besar sudah terbukti menurunkan morbiditas
dan mortalitas pasien PGK
• Perkembangan lebih lanjut dengan terapi konvektif dapat
mengeluarkan toksin yang lebih besar (LMWP, protein bound
UT), high, medium cutoff , protein adsorptive membranes
• Kerugiannya, dapat kehilangan albumin
25. Recommended Clinical Parameter
Treatment duration: ≤6 h
Blood flow rate: 0~300ml/min
Anticoagulant: Heparin first dosage: double of HD
loading dosage: same as HD
Citrate same dosage as CRRT
26. Penutup
• Pada PGK toksin uremik semakin meningkat
• Toksin uremik, terutama middle molecule (MM) atau yang lebih
besar, sangat mempengaruhi morbiditas dan mortalitas
kardiovaskular
• Hemodialisis konvensional tidak dapat mengeluarkan MM
• Sudah terbukti bahwa pengeluaran MM memperbaiki
prognosis pasien, menurunkan mortalitas KV
• Obat-obat, diet, dapat mengurangi TU di usus
• Hemoperfusi mempunyai banyak manfaat
Editor's Notes
Usually, the doctor use hemodialysis and hemofilter,
HD is based on the principle of diffusion. During the treatment, the doctor use fresh dialysate to remove the toxins and maintain water balance. HF is based on convection, the pressure in the filter will push the toxins and water to the filtrate, and substitution should be added as the replacement of filtrate. Based on the diffusion and convection , hemodiafiltation is the combination of HF and HD. The fresh dialysate and substitution are both needed.
The common modes of continuous-renal-replacement-therapy are CVVH, CVVHD, CVVHDF which are similar to HF, HD, HDF.
CRRT treatment is more continuous and stable. So the CRRT treatment is always used for critically ill patients.
But no matter which mode is based on membrane technology can not efficiently remove the middle toxins and protein bound toxins..
Hemoperfusion is a blood purification treatment based on adsorption technology.
Hemoperfusion is a method that uses adsorbent to adsorb toxins, drugs and metabolites and clear them from blood.
Imagine this is absorbent, inside the cartridge are resins with specific structure.
When the treatment starts, blood goes from the bottom to the top.
Small molecular will go through, and the aim molecules like middle toxins or protein bound toxins will be caught by the resin. While the blood cells will pass by without any damage.
From this table, we can see, the difference between HP and other mode.
From the clearance range, the HP can remove mid-large molecules and others mainly to remove small and some large molecules.
The advantage of HP is broad application and use with other mode and the disadvantage is can’t regulate water, acid base balance.
Hemoperfusion has a wide use today.
It can be used for many application. Use our products as the example.
HA130 for esrd, HA330 for critical ill, HA230 for poisoning, DNA280 for immune disease, and BS330 and HA330-2 for liver disease.
HA130 is always used with hemodialysis for ESRD, to clear the uremic toxins such as PTH, leptin, B2-MG and relieve the symptoms of ESRD complications.
HA230 for various drug poisoning and intoxication to remove the drugs, biotoxins such as snake venom, large amount pesticide for suicide, and even mental-ion.
HA330 can removes the inflammatory mediators and regulates the body immunity for critically-ill patients in the ICU and those undergoing cardiac surgery. It effectively clears the excessive cytokines, activated complement, plasma free hemogoblin and so on .
BS330 and HA330-2 are combined as a system called DPMAS for hepatopathy, which can effectively remove bilirubin, bile acid, endotoxins and inflammatory mediators.
DNA230 and HA280 for immune disease, DNA230 is used for Systematic lupus erythematosus, it specifically absorb ANA& anti-ds DNA. And HA280 is used to remove immune related pathogenic factors such as IL-1,IL-6, TNF-a and middle toxins such as leptin, PTH, CRP.
适应症写详细，讲清楚每个罐子清除的东西
Because of the wide indications of hemoperfusion, clinical use it very frequently today.
These are the basic clinical parameter .
The recommended treatment duration is less than 6h
And the blood flow is recommended between 0 ~300ml/min
The common use of anticoagulant is heparin. The first dosage is commonly used double than HD, and the loading dosage is normally same as HD
When HP combine with CRRT, citrate is another common uses antigcoagulant, the dosage is same as CRRT.
