Clinical use of plasmafiltration coupled with adsorption
Keywords:
coupled plasma filtration adsorption, detoxification, sepsis, rhabdomyolysis, liver failure
Abstract
Coupled plasma filtration adsorption is an extracorporeal therapy that combines plasma separation and adsorption of inflammatory mediators and toxins, followed by hemofiltration to control volume overload and removal of small and medium-sized water-soluble mediators. Although it is not new, there are still doubts about its clinical role. Evidence indicates that the coupled plasma filtration adsorption is highly efficient in removing inflammatory molecules in sepsis. So far it has not been shown to reduce mortality, but it is possible to achieve a better hemodynamic benefit over convective therapies. On the other hand, the adsorptive component makes it possible to purify larger mediators associated with causes of non-septic acute kidney injury, such as myoglobin, toxins associated with liver failure and others, allowing that coupled plasma filtration adsorption indications to be expanded to various clinical settings with a high inflammatory component, particularly when it is required to manage several organ dysfunctions simultaneously.
References
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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.
29) Berlot G, Falini S, Negro V, Agbedjro A, Tomasini A, Iscra F, et al. Influence of timing of initiation and volume of processed plasma on the outcome of septic shock patients treated with coupled plasma filtration and adsorption. Blood Purif. 2018;46(4):274-78. doi: 10.1159/000490611.
30) Vassallo MC, Tartamella F, Bhakta P. Regional citrate anticoagulation during coupled plasma filtration and adsorption may increase survival in septic shock. Blood Purif. 2019;47(1-3):109-110. doi: 10.1159/000493538.
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Published
2022-06-15
How to Cite
1.
Pedreros-Rosales C, Müller-Ortiz H, Colomina-Climent F. Clinical use of plasmafiltration coupled with adsorption. Rev Nefrol Dial Traspl. [Internet]. 2022Jun.15 [cited 2024Dec.27];42(2):153-65. Available from: http://revistarenal.org.ar/index.php/rndt/article/view/794
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Review Article
Copyright (c) 2022 Revista de Nefrología, Diálisis y Trasplante
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