Hemoperfusión en pacientes con enfermedades críticas e injuria renal aguda. Reporte de tres casos
Palabras clave:
hemoperfusión, injuria renal aguda, unidad de cuidados críticos, mortalidad, sepsis, hemodiálisis, diálisis renal
Resumen
La hemoperfusión es una técnica de aclaramiento extracorpóreo de moléculas de mediano y gran peso molecular, lipofílicas y de alta unión a proteínas plasmáticas, basada en el principio físico de adsorción. Puede usarse de forma aislada o combinada con otras técnicas, como hemodiálisis convencional, hemodiálisis híbrida o terapia de reemplazo renal continua. Se reportan tres pacientes (dos con pancreatitis severa y uno con sepsis asociada a leptospirosis) que desarrollaron injuria renal aguda y fueron tratados mediante hemoperfusión combinada con hemodiálisis convencional en la Unidad de Cuidados Intensivos (UCI). Se evidenció depuración significativa de toxinas urémicas y citoquinas proinflamatorias, además de otras moléculas como enzimas digestivas y creatinfosfokinasa. El futuro de esta técnica adsortiva, innovadora en el tratamiento de condiciones sistémicas inflamatorias, requiere todavía de mayor evidencia para demostrar su utilidad para prevenir la mortalidad de pacientes críticos.
Citas
1) Gurland HJ, Davison AM, Bonomini V, Falkenhagen D, Hansens S, Kishimoto T, et al. Definitions and terminology in biocompatibility. Nephrol Dial Transplant. 1994;9(Suppl. 2):4-10.
2) Muirhead EE, Reid AF. A resin artificial kidney. J Lab Clin Med. 1948;33(7):841-4.
3) Daurgidas JT, Blaker PG, Ing TS. Manual de diálisis. 5a ed. Barcelona: Wolters Kluwer, 2015.
4) Ankawi G, Fan W, Pomarè Montin D, Lorenzin A, Neri M, Caprara C, et al. A new series of sorbent devices for multiple clinical purposes: current evidence and future directions. Blood Purif. 2019;47(1-3):94-100. doi: 10.1159/000493523.
5) Li Z, Wang G, Zhen G, Zhang Y, Liu J, Liu S. Effects of hemodialysis combined with hemoperfusion on severe acute pancreatitis. Turk J Gastroenterol. 2018;29(2):198-202. doi: 10.5152/tjg.2018.17415.
6) Pomarè Montin D, Ankawi G, Lorenzin A, Neri M, Caprara C, Ronco C. Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion. Blood Purif. 2018;46(3):187-95. doi: 10.1159/000489921.
7) Honoré PM, De Bels D, Barreto Gutierrez L, Spapen HD. Hemoadsorption therapy in the critically ill: solid base but clinical haze. Ann Intensive Care. 2019;9(1):22. doi: 10.1186/s13613-019-0491-1.
8) Liu LY, Zhu YJ, Li XL, Liang YF, Liang ZP, Xia YH. Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome. World J Emerg Med. 2012;3(1):44-8. doi: 10.5847/wjem.j.issn.1920-8642.2012.01.008.
9) Hato T, Dagher PC. How the innate immune system senses trouble and causes trouble. Clin J Am Soc Nephrol. 2015;10(8):1459-69. doi: 10.2215/CJN.04680514.
10) Weisheit CK, Engel DR, Kurts C. Dendritic cells and macrophages: sentinels in the kidney. Clin J Am Soc Nephrol. 2015;10(10):1841-51. doi: 10.2215/CJN.07100714.
11) Tsujimoto H, Ono S, Hiraki S, Majima T, Kawarabayashi N, Sugasawa H, et al. Hemoperfusion with polymyxin B-immobilized fibers reduced the number of CD16+ CD14+ monocytes in patients with septic shock. J Endotoxin Res. 2004;10(4):229-37. doi: 10.1179/096805104225005814.
12) Wang YT, Fu JJ, Li XL, Li YR, Li CF, Zhou CY. Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome. Eur Rev Med Pharmacol Sci. 2016;20(4):745-50.
13) Sato N, Kojima K, Horio Y, Goto E, Masunaga A, Ichiyasu H, et al. Successful treatment of severe amiodarone pulmonary toxicity with polymyxin B-immobilized fiber column direct hemoperfusion. Chest. 2013;143(4):1146-50. doi: 10.1378/chest.12-0994.
14) Li WH, Yin YM, Chen H, Wang XD, Yun H, Li H, et al. Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus. Medicine (Baltimore). 2017;96(12):e6160. doi: 10.1097/MD.0000000000006160.
15) Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS One. 2017;12(10):e0187015. doi: 10.1371/journal.pone.0187015.
16) Huang Z, Wang SR, Su W, Liu JY. 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. doi: 10.1111/j.1744-9987.2010.00825.x.
17) Hong B, Ling Z, Songmin H, Tao Z, Ruichao Y. Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis. Ren Fail. 2012;34(3):383-6. doi: 10.3109/0886022X.2011.647370.
18) Hu XB, Gao HB, Liao ME, He MR. The use of HA330-II microporous resin plasma adsorption in the treatment of chronic severe hepatitis. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19(12):760-1.
2) Muirhead EE, Reid AF. A resin artificial kidney. J Lab Clin Med. 1948;33(7):841-4.
3) Daurgidas JT, Blaker PG, Ing TS. Manual de diálisis. 5a ed. Barcelona: Wolters Kluwer, 2015.
4) Ankawi G, Fan W, Pomarè Montin D, Lorenzin A, Neri M, Caprara C, et al. A new series of sorbent devices for multiple clinical purposes: current evidence and future directions. Blood Purif. 2019;47(1-3):94-100. doi: 10.1159/000493523.
5) Li Z, Wang G, Zhen G, Zhang Y, Liu J, Liu S. Effects of hemodialysis combined with hemoperfusion on severe acute pancreatitis. Turk J Gastroenterol. 2018;29(2):198-202. doi: 10.5152/tjg.2018.17415.
6) Pomarè Montin D, Ankawi G, Lorenzin A, Neri M, Caprara C, Ronco C. Biocompatibility and Cytotoxic Evaluation of New Sorbent Cartridges for Blood Hemoperfusion. Blood Purif. 2018;46(3):187-95. doi: 10.1159/000489921.
7) Honoré PM, De Bels D, Barreto Gutierrez L, Spapen HD. Hemoadsorption therapy in the critically ill: solid base but clinical haze. Ann Intensive Care. 2019;9(1):22. doi: 10.1186/s13613-019-0491-1.
8) Liu LY, Zhu YJ, Li XL, Liang YF, Liang ZP, Xia YH. Blood hemoperfusion with resin adsorption combined continuous veno-venous hemofiltration for patients with multiple organ dysfunction syndrome. World J Emerg Med. 2012;3(1):44-8. doi: 10.5847/wjem.j.issn.1920-8642.2012.01.008.
9) Hato T, Dagher PC. How the innate immune system senses trouble and causes trouble. Clin J Am Soc Nephrol. 2015;10(8):1459-69. doi: 10.2215/CJN.04680514.
10) Weisheit CK, Engel DR, Kurts C. Dendritic cells and macrophages: sentinels in the kidney. Clin J Am Soc Nephrol. 2015;10(10):1841-51. doi: 10.2215/CJN.07100714.
11) Tsujimoto H, Ono S, Hiraki S, Majima T, Kawarabayashi N, Sugasawa H, et al. Hemoperfusion with polymyxin B-immobilized fibers reduced the number of CD16+ CD14+ monocytes in patients with septic shock. J Endotoxin Res. 2004;10(4):229-37. doi: 10.1179/096805104225005814.
12) Wang YT, Fu JJ, Li XL, Li YR, Li CF, Zhou CY. Effects of hemodialysis and hemoperfusion on inflammatory factors and nuclear transcription factors in peripheral blood cell of multiple organ dysfunction syndrome. Eur Rev Med Pharmacol Sci. 2016;20(4):745-50.
13) Sato N, Kojima K, Horio Y, Goto E, Masunaga A, Ichiyasu H, et al. Successful treatment of severe amiodarone pulmonary toxicity with polymyxin B-immobilized fiber column direct hemoperfusion. Chest. 2013;143(4):1146-50. doi: 10.1378/chest.12-0994.
14) Li WH, Yin YM, Chen H, Wang XD, Yun H, Li H, et al. Curative effect of neutral macroporous resin hemoperfusion on treating hemodialysis patients with refractory uremic pruritus. Medicine (Baltimore). 2017;96(12):e6160. doi: 10.1097/MD.0000000000006160.
15) Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial. PLoS One. 2017;12(10):e0187015. doi: 10.1371/journal.pone.0187015.
16) Huang Z, Wang SR, Su W, Liu JY. 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. doi: 10.1111/j.1744-9987.2010.00825.x.
17) Hong B, Ling Z, Songmin H, Tao Z, Ruichao Y. Continuous venovenous hemofiltration and hemoperfusion in successful treatment of a patient with crush syndrome and acute pancreatitis. Ren Fail. 2012;34(3):383-6. doi: 10.3109/0886022X.2011.647370.
18) Hu XB, Gao HB, Liao ME, He MR. The use of HA330-II microporous resin plasma adsorption in the treatment of chronic severe hepatitis. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007;19(12):760-1.
Publicado
2021-03-25
Cómo citar
1.
Cruz Llanos LE, Valenzuela Córdova CR, León Rabanal CP, Cieza Zevallos JA. Hemoperfusión en pacientes con enfermedades críticas e injuria renal aguda. Reporte de tres casos. Rev Nefrol Dial Traspl. [Internet]. 25 de marzo de 2021 [citado 27 de diciembre de 2024];41(1):48-4. Disponible en: http://vps-1689312-x.dattaweb.com/index.php/rndt/article/view/617
Sección
Casuística
Derechos de autor 2021 Revista de Nefrología, Diálisis y Trasplante
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0.
