Acute blood purification options
Fresenius Medical Care supports a wide range of acute blood purification options, primarily in intensive care.
Continuous kidney replacement therapy (CKRT)
As its name suggests, CKRT is intended to continuously replace certain kidney functions. This therapy is preferable for hemodynamically unstable patients or patients at risk for increased intracranial pressure as it enables continuous management of patient fluid volume and a slow but steady removal of toxins.1
CKRT includes convective and diffusive therapy modalities, e.g.:
- Continuous veno-venous hemodialysis (CVVHD)
- Continuous veno-venous hemofiltration (CVVH)
- Continuous veno-venous hemodiafiltration (CVVHDF)
Efficient anticoagulation of the extracorporeal blood circuit is essential for reliable renal replacement therapy. Following the KDIGO AKI clinical practice guideline, regional citrate anticoagulation has become widely accepted in a number of countries.1,2
To provide reliable regional citrate anticoagulation, Fresenius Medical Care developed its comprehensive Ci‑Ca therapy together with experienced clinicians. Since its introduction, healthcare professionals in over 30 countries have gained experience with Ci‑Ca therapy.
CKRT and reduction of pathogens and cytokines
Targeting beyond the removal of uremic toxins with CKRT devices may be an option to consider when treating critically ill patients with incipient or advanced sepsis or septic shock.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to an infection.3 An uncontrolled inflammatory response often leads to severe and life-threatening hemodynamic instability and multiple organ dysfunction syndrome (MODS).
Reducing the peaks of the cytokine concentration typically involved in the inflammatory response with a continuously acting therapy such as CKRT has been proposed as a reasonable approach.4 Moreover, pathogen adsorption may represent a promising tool as binding to a purpose-created surface may reduce pathogens in blood stream infections.5
Our multiFiltratePRO device allows the application of certain whole-blood adsorbers designed to
- reduce circulating pathogens in adjunction to antibiotic treatment in case of blood stream infection (Seraph 100*)
- adsorb various cytokines, bilirubin, and myoglobin (CytoSorb*)
* Seraph 100 Microbind Affinity Blood Filter and CytoSorb 300 mL are compatible with multiFiltratePRO and multiFiltrate devices. Legal manufacturer of Seraph 100 is ExThera Medical Corp., USA. Legal manufacturer of CytoSorb is CytoSorbents Corporation, USA.
CO2 removal in combination with CKRT
Kidney and lung are deeply interconnected and their respective acute failures can strongly influence one another.6 A substantial number of patients suffer from both ARDS requiring mechanical ventilation and AKI. For such patients, combining ECCO2R with CKRT in a single extracorporeal circuit has been suggested as an attractive therapeutic option.7
Blood-gas exchangers enable extracorporeal carbon dioxide removal (ECCO2R) and may support the management of acute respiratory dysfunction syndrome (ARDS) by removing excessive CO2 from the bloodstream.8
The multiECCO2R* gas exchanger enables the delivery of low-flow ECCO2R in combination with CKRT simultaneously on a single therapy system using one vascular access.9
* Legal manufacturer of multiECCO2R is EUROSETS S.r.l., Italy. Fresenius Medical Care Deutschland GmbH is a distributor of multiECCO2R in selected countries.
Therapeutic plasma exchange
Therapeutic plasma exchange (TPE) is a well-established extracorporeal blood purification technique supporting the “removal of pathological substances from the blood, such as monoclonal paraproteins and autoantibodies, as well as the replacement of deficient plasma components when plasma is used as a replacement fluid.”10
Indications for TPE cover selected diagnoses from different specialities such as neurology, hematology, rheumatology and nephrology.10
Our CKRT device multiFiltratePRO supports a convenient delivery of TPE with comprehensive user guidance and integrated automated plasma volume calculation according to Sprenger et al.11, as well as an automated ramp-up of plasma separation. Plasma and blood cells are separated by using one of our validated plasmaFlux filters.
1 KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl 2012; 2:1-138
2 Kindgen-Milles D et al. Curr Opin Crit Care 2018; 24:450‑454
3 Singer M et al. JAMA 2016; 315(8):801‑810
4 Ronco C et al. Artif Organs 2003; 27(9):792‑801
5 Monard C et al. Blood Purif 2022; doi: 10.1159/000524973
6 Singbartl K. Contrib Nephrol 2011; 174:65‑70
7 Jacobs et al. Respir Care 2020; 65(4):517‑524
8 Morimont P et al. Crit Care 2015; 19:117
9 Husain-Syed F et al. Front Med 2020; 7:598379
10 Reeves HM et al. Br J Haematol. 2014; 164:342‑351
11 Sprenger KB et al. J Clin Apher 1987; 3:185‑190