Uso clínico de la plasmafiltración acoplada con adsorción
Palabras clave:
adsorción por filtración de plasma acoplado, desintoxicación, sepsis, rabdomiólisis, insuficiencia hepática
Resumen
La filtración de plasma acoplada con adsorción es una terapia extracorpórea que combina la separación de plasma y adsorción de mediadores inflamatorios y toxinas, seguida de hemofiltración para control de la sobrecarga de volumen y eliminación de mediadores hidrosolubles pequeños y medianos. Aunque no es nueva, aún existen dudas acerca de su rol clínico. La evidencia señala que la filtración de plasma acoplada con adsorción es altamente eficiente en remover moléculas inflamatorias en sepsis y, aunque hasta ahora no ha demostrado disminuir la mortalidad, si es posible conseguir mayor beneficio hemodinámico que las terapias convectivas. Por otra parte, el componente adsortivo permite depurar mediadores más grandes asociados a causas de lesión renal aguda no séptica, tales como mioglobina, toxinas asociadas con insuficiencia hepática y otros tóxicos, permitiendo expandir las indicaciones de filtración de plasma acoplada con adsorción a varios cuadros clínicos con gran componente inflamatorio, particularmente cuando se requiere manejar varias disfunciones orgánicas simultáneamente.
Citas
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3) Berlot G, Di Capua G, Nosella P, Rocconi S, Thomann C. Plasmapheresis in sepsis. Contrib Nephrol. 2004;144:387-94. doi: 10.1159/000078904.
4) Davies B, Cohen J. Endotoxin removal devices for the treatment of sepsis and septic shock. Lancet Infect Dis. 2011;11(1):65-71. doi: 10.1016/S1473-3099(10)70220-6.
5) Bellomo R, Tetta C, Ronco C. Coupled plasma filtration adsorption. Intensive Care Med. 2003;29(8):1222-8. doi: 10.1007/s00134-003-1796-x.
6) Girardot T, Schneider A, Rimmelé T. Blood Purification Techniques for Sepsis and Septic AKI. Semin Nephrol. 2019;39(5):505-14. doi: 10.1016/j.semnephrol.2019.06.010.
7) La Manna G, Donati G. Coupled plasma filtration adsorption: A multipurpose extracorporeal detoxification therapy. Blood Purif. 2018;46(3):228-38. doi: 10.1159/000490234.
8) Morgera S, Rocktäschel J, Haase M, Lehmann C, von Heymann C, Ziemer S, et al. Intermittent high permeability hemofiltration in septic patients with acute renal failure. Intensive Care Med. 2003;29(11):1989-95. doi: 10.1007/s00134-003-2003-9.
9) Li J, Li D, Xu Y, Wang A, Xu C, Yu C. The optimal timing of hemoperfusion component in combined hemodialysis-hemoperfusion treatment for uremic toxins removal. Ren Fail. 2015;37(1):103-7. doi: 10.3109/0886022X.2014.976131.
10) Park S, Islam MI, Jeong JH, Cho NJ, Song HY, Lee EY, et al. Hemoperfusion leads to impairment in hemostasis and coagulation process in patients with acute pesticide intoxication. Sci Rep. 2019;9(1):13325. doi: 10.1038/s41598-019-49738-1.
11) Ronco C, Brendolan A, d'Intini V, Ricci Z, Wratten ML, Bellomo R. Coupled plasma filtration adsorption: rationale, technical development and early clinical experience. Blood Purif. 2003;21(6):409-16. doi: 10.1159/000073444.
12) Tetta C, Cavaillon JM, Schulze M, Ronco C, Ghezzi PM, Camussi G, et al. Removal of cytokines and activated complement components in an experimental model of continuous plasma filtration coupled with sorbent adsorption. Nephrol Dial Transplant. 1998;13(6):1458-64. doi: 10.1093/ndt/13.6.1458.
13) Tetta C, Gianotti L, Cavaillon JM, Wratten ML, Fini M, Braga M, et al. Coupled plasma filtration-adsorption in a rabbit model of endotoxic shock. Crit Care Med. 2000;28(5):1526-33. doi: 10.1097/00003246-200005000-00045.
14) Sykora R, Chvojka J, Krouzecky A, Radej J, Kuncova J, Varnerova V, et al. Coupled plasma filtration adsorption in experimental peritonitis-induced septic shock. Shock. 2009;31(5):473-80. doi: 10.1097/SHK.0b013e318188dec5.
15) Bouman CS, Oudemans-van Straaten HM, Schultz MJ, Vroom MB. Hemofiltration in sepsis and systemic inflammatory response syndrome: the role of dosing and timing. J Crit Care. 2007;22(1):1-12. doi: 10.1016/j.jcrc.2006.05.002.
16) Bagshaw SM, Wald R. Strategies for the optimal timing to start renal replacement therapy in critically ill patients with acute kidney injury. Kidney Int. 2017;91(5):1022-32. doi: 10.1016/j.kint.2016.09.053.
17) Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304-77. doi: 10.1007/s00134-017-4683-6.
18) Lentini P, Cruz D, Nalesso F, de Cal M, Bobek I, Garzotto F, et al. Coupled plasma filtration adsorption (CPFA) versus emofiltrazione continua con regime intermittente di alti volumi (pHVHF) nel trattamento dello shock settico: uno studio pilota. G Ital Nefrol. 2009;26(6):695-703.
19) Ronco C, Brendolan A, Lonnemann G, Bellomo R, Piccinni P, Digito A, et al. A pilot study of coupled plasma filtration with adsorption in septic shock. Crit Care Med. 2002;30(6):1250-5. doi: 10.1097/00003246-200206000-00015.
20) Formica M, Olivieri C, Livigni S, Cesano G, Vallero A, Maio M, et al. Hemodynamic response to coupled plasmafiltration-adsorption in human septic shock. Intensive Care Med. 2003;29(5):703-8. doi: 10.1007/s00134-003-1724-0.
21) Berlot G, Agbedjro A, Tomasini A, Bianco F, Gerini U, Viviani M, 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):146-51. doi: 10.1159/000360268.
22) Hu D, Sun S, Zhu B, Mei Z, Wang L, Zhu S, et al. Effects of coupled plasma filtration adsorption on septic patients with multiple organ dysfunction syndrome. Ren Fail. 2012;34(7):834-9. doi: 10.3109/0886022X.2012.684553.
23) Turani F, Falco M, Natoli S, Leonardis F, Fede M, Berlot G, et al. Coupled plasma filtration and adsorption in septic shock: a multicentric experience. Crit Care. 2010;14(Suppl. 1):P412. doi: 10.1186/cc8644.
24) Berlot G, Bianco N, Tomasini A, Vassallo MC, Bianco F. Changes in microvascular blood flow during coupled plasma filtration and adsorption. Anaesth Intensive Care. 2011;39(4):687-9. doi: 10.1177/0310057X110390042.
25) Livigni S, Bertolini G, Rossi C, Ferrari F, Giardino M, Pozzato M, et al; GiViTI: Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open. 2014;4(1):e003536. doi: 10.1136/bmjopen-2013-003536.
26) Garbero E, Livigni S, Ferrari F, Finazzi S, Langer M, Malacarne P, et al.; GiViTI: Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. High dose coupled plasma filtration and adsorption in septic shock patients. Results of the COMPACT-2: a multicentre, adaptive, randomised clinical trial. Intensive Care Med. 2021;47(11):1303-11. doi: 10.1007/s00134-021-06501-3.
27) Colomina-Climent F, Giménez-Esparza C, Portillo-Requena C, Allegue-Gallego JM, Galindo-Martínez M, Mollà-Jiménez C, et al. Mortality reduction in septic shock by plasma adsorption (ROMPA): a protocol for a randomised clinical trial. BMJ Open. 2016;6(7):e011856. doi: 10.1136/bmjopen-2016-011856.
28) Giménez-Esparza C, Portillo-Requena C, Colomina-Climent F, Allegue-Gallego JM, Galindo-Martínez M, Mollà-Jiménez C, et al. The premature closure of ROMPA clinical trial: mortality reduction in septic shock by plasma adsorption. BMJ Open. 2019;9(12):e030139. doi: 10.1136/bmjopen-2019-030139.
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Publicado
2022-06-15
Cómo citar
1.
Pedreros-Rosales C, Müller-Ortiz H, Colomina-Climent F. Uso clínico de la plasmafiltración acoplada con adsorción. Rev Nefrol Dial Traspl. [Internet]. 15 de junio de 2022 [citado 20 de abril de 2024];42(2):153-65. Disponible en: http://revistarenal.org.ar/index.php/rndt/article/view/794
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Derechos de autor 2022 Revista de Nefrología, Diálisis y Trasplante
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial-CompartirIgual 4.0.
