Author: Kishikawa, Tatsuya ; Sugaya, Hiroyuki ; Osuka, Tomoaki ; Nakada, Masaru ; Sugata, Toru ; Fujita, Masaki ; Fujieda, Hiroaki ; Osabe, Masahiro ; Kanda, Junko ; Sakaguchi, Hirokazu ; Ueno, Yoshiyuki

Background::

Dialysis-related amyloidosis (DRA) is a serious complication in chronic kidney disease patients on long-term dialysis, caused by β 2 -microglobulin (β 2 -MG) accumulation, and remains challenging owing to the growing dialysis population and extended treatment duration.

Objectives::

To develop and evaluate stereocomplex poly(methyl methacrylate) (PMMA) adsorbent fibers with optimized cross-sectional and nanoporous structures for efficient, selective β 2 -MG removal.

Methods::

Structured PMMA fibers were fabricated via dry-wet spinning. The adsorption performance of optimized fibers was evaluated with serum containing β 2 -MG and other solutes, using scanning electron microscopy (SEM), three-dimensional transmission electron microscopy (3D-TEM), and time-of-flight secondary ion mass spectrometry (TOF-SIMS). Pressure loss simulations compared fiber- and bead-packed columns.

Results::

Fibers with 12–15 nm pores exhibited maximal β 2 -MG adsorption. Cross-shaped fibers exhibited the highest blood-contact surface area and adsorption capacity. A thin surface-dense layer (<0.1 μm) improved β 2 -MG diffusion while limiting albumin uptake. TOF-SIMS confirmed uniform β 2 -MG penetration, with albumin confined near the fiber surface. Adsorption exceeded 50% for mid-weight proteins (~52 kDa), including IL-6, α 1 -microglobulin (α 1 -MG), and TNF-α. Pressure loss simulations showed that fiber-packed columns had lower resistance than bead-packed columns.

Conclusions::

Optimized cross-shaped PMMA fibers enable efficient, selective β 2 -MG removal and favorable flow dynamics for hemoperfusion therapies targeting mid-weight uremic toxins.

01 Jan 2023·Contributions to Nephrology

Adsorption of Endotoxin and Mitigation of Sepsis

Review

Author: Shoji, Hisataka ; Foster, Debra M ; Walker, Paul M ; Walker, Paul M. ; Kellum, John A. ; Kellum, John A ; Foster, Debra M.

In the fields of sepsis and systemic inflammation, endotoxin might be the most studied molecule since the term was coined by Richard Pfeiffer in 1892. Paradoxically measuring endotoxin in humans and finding an effective treatment for endotoxemia have remained challenging. While advances have been made in understanding the mechanisms of how this simple molecule can trigger an intense immune cascade, there is an ever growing need to develop better treatments. Studies measuring endotoxin levels in patients with septic shock have consistently demonstrated that there is a dose-response relationship between endotoxin levels and adverse outcomes. A rapid assay to measure endotoxin activity has been available for more than a decade, but few studies have synergized the assay with a therapeutic. Polymyxin B hemoperfusion (PMX-HP) leverages a molecule with high affinity for endotoxin with a technique to eliminate exposure. Polymyxin is bound and immobilized to fibers within a cartridge and administered as an extracorporeal therapy via veno-venous hemoperfusion. Clinical evidence of its use is plentiful yet inconsistent in studies based on an outcome for mortality at 28 days. Herein, we describe targeted patient selection using the endotoxin activity assay and clinical phenotyping followed by adsorption of endotoxin using the PMX-HP for endotoxemic sepsis.

01 Dec 2022·Journal of Anesthesia, Analgesia and Critical Care (Online)

Potential survival benefit and early recovery from organ dysfunction with polymyxin B hemoperfusion: perspectives from a real-world big data analysis and the supporting mechanisms of action

Review

Author: Shoji, Hisataka ; Ferrer, Ricard

Abstract:

Background:

Endotoxin (ET) removal therapy with polymyxin B-immobilized fiber column hemoperfusion (PMX-HP) has been used for the treatment of septic shock. Some observational studies reported clinical benefits, particularly in specific subgroups of patients. However, larger randomized controlled trial results have been disappointing.

Main body:

The four studies that revealed the survival benefit of PMX-HP were based on the Japanese Diagnosis Procedure Combination (DPC) national inpatient database (J-DPC study). Nevertheless, one J-DPC study and a randomized controlled trial (RCT) conducted in France evaluated PMX-HP in patients with abdominal septic shock and did not report a significant survival benefit. In both studies, the severity of illness was too low to find substantial significant differences in mortality. The results of the J-DPC studies further suggest that some subpopulations of patients could benefit from PMX-HP. Based on these results, this review revisited prior RCTs and other large-scale studies on PMX-HP. In addition, four J-DPC studies and one large-scale study reported a survival benefit with PMX-HP. A secondary analysis of the EUPHRATES trial, the most recent double-blinded RCT of PMX-HP conducted in North America, suggested a survival benefit in patients with high levels of endotoxemia. In the J-DPC studies and the EUPHRATES trial, ventilator-free days, vasoactive drug-free days, and renal replacement-free days were significantly improved in the PMX-HP groups. These findings suggest that PMX-HP can contribute to early recovery from organ dysfunction. The reduction of supportive care likely provides important health and economic benefits for managing patients with septic shock. Finally, the blood levels of mediators or biomarkers related to respiratory, cardiovascular, and renal dysfunction have been reported to be normalized with PMX-HP.

Conclusions:

These results support the biological rationale for the improvement in organ dysfunction observed in the J-DPC studies and other large-scale studies, including the EUPHRATES trial. Real-world evidence from large data sets suggests an appropriate patient population that are likely to benefit from the utility of PMX-HP for septic shock.

News (Medical) associated with Toray Medical Co., Ltd.

23 Dec 2022

·www.prnewswire.com

Continuous Renal Replacement Therapy Market to Reach US$ 2.5 Bn by 2031, TMR Study

Novel practice of adoption of sorbent-based techniques and incorporation of nanotechnology propels growth Expanding geriatric population susceptible to chronic kidney diseases, drives demand within the market WILMINGTON, Del., Dec. 23, 2022 /PRNewswire/ -- The future market analysis of continuous renal replacement therapy projects that the industry will rise at a CAGR of 7.5 % from 2022 to 2031. The market was valued at US$ 1.2 Bn in 2021. The continuous renal replacement therapy market (CRRT) is a preferred therapeutic treatment procedure to manage the hemodynamic status of individuals suffering from acute kidney injury. Growth in the number of dialysis units and centers across the world is propelling demand within the market. Furthermore, growing prevalence of acute kidney injuries (AKI), as well as chronic kidney disease (CKD), is also driving market growth. Continuous Renal Replacement Therapy Market – Key Findings of the Report Increasing Prevalence of Chronic Kidney Diseases or CKDs: Rising prevalence of chronic kidney diseases, as well as growth in the number of geriatric individuals who are more susceptible to these conditions, is driving market growth. As per a survey by the United Nations, the total number of geriatric individuals is expected to reach 1.5 Bn by the end of 2050. This growing number of individuals above 65 years, living with various chronic illnesses, including CKDs, is expected to propel market development over the next decade. Furthermore, in 2017, the global prevalence of CKD was calculated at 9.1 % of the total population, accounting for 700 Mn cases of the disease. Get Exclusive PDF Sample Copy of Continuous Renal Replacement Therapy Market – Continuous Renal Replacement Therapy Market – Growth Drivers Rising pool of geriatric population suffering from chronic diseases boosts market development Increase in the number of dialysis centers across the world aids in the expansion of continuous renal replacement therapy market share Advancements in medical technologies and incorporation of artificial intelligence and nano technologies bolsters market expansion Continuous Renal Replacement Therapy Market – Key Players Some of the key players for continuous renal replacement therapy procedure are Nipro Corporation, Asahi Kasei Corporation, Medica SpA, Medtronic, Toray Industries, Inc., Baxter International, Inc., Fresenius Medical Care AG & Co. KGaA, B. Braun Melsungen AG, INFOMED SA, and Toray Medical Company Limited. Industry players are focused on adopting various inorganic and organic expansion strategies in order to enhance their industry share and attract more customers. For instance, players are adopting strategies like mergers and acquisitions, as well as research and development in order to create new revenue streams and enter new geographical regions. Ask for References – Continuous Renal Replacement Therapy Market: Regional Growth Assessment Europe accounted for the largest continuous renal replacement market share and is expected to maintain its dominant position over the next decade. Some of the key drivers behind considerable expansion of the Europe market include rising incidence rate of acute kidney injuries and chronic kidney diseases, as well as the presence of favorable healthcare reimbursement policies in the region. Apart from this, other notable drivers for the Europe industry include presence of well-trenched R&D infrastructure, and established industry players, as well as availability of sizable government funding to facilitate continuous renal replacement therapy (CRRT) for patients that are critically ill. Apart from Europe, Asia Pacific region is anticipated to register considerable growth in the global market in coming years. Some of the key drivers behind growth of this regional market include increase in investments to enhance healthcare infrastructure, as well as rising pool of geriatric population. Furthermore, growing investments aimed at developing, as well as acquiring next generation and technologically advanced CRRT products is also positively affecting demand dynamics in the Asia Pacific market. Continuous Renal Replacement Therapy Market: Segmentation Continuous Renal Replacement Therapy Market, by Mode Slow Continuous Ultrafiltration (SCUF) Continuous Venovenous Hemofiltration (CVVHF) Continuous Venovenous Hemodialysis (CVVHD) Continuous Venovenous Hemodiafiltration (CVVHDF) Continuous Renal Replacement Therapy Market, by Product Dialysate & Replacement Fluids Disposables Systems Continuous Renal Replacement Therapy Market, by Therapy Renal Non-renal Combination Continuous Renal Replacement Therapy Market, by End-user Hospitals Clinics Others Continuous Renal Replacement Therapy Market, by Region North America Europe Asia Pacific Latin America Middle East & Africa Buy this Premium Research Report | Immediate Delivery Available – Modernization of healthcare in terms of both infrastructure and services have pushed the healthcare industry to new heights, Stay Updated with Latest Healthcare Research Reports by Transparency Market Research: Electric Tooth Polisher Market Dental Air Abrasion Market Dental Night Guard Market Pediatric Perfusion Products Market Dental Gypsum Market Stethoscope Market Vagus Nerve Stimulator Market PEEK Dental Implants Market About Transparency Market Research Transparency Market Research, a global market research company registered at Wilmington, Delaware, United States, provides custom research and consulting services. Our exclusive blend of quantitative forecasting and trends analysis provides forward-looking insights for thousands of decision makers. Our experienced team of Analysts, Researchers, and Consultants use proprietary data sources and various tools & techniques to gather and analyses information. Our data repository is continuously updated and revised by a team of research experts, so that it always reflects the latest trends and information. With a broad research and analysis capability, Transparency Market Research employs rigorous primary and secondary research techniques in developing distinctive data sets and research material for business reports. For More Research Insights on Leading Industries, Visit Our YouTube Channel and hit subscribe for Future Update - Contact Nikhil Sawlani Transparency Market Research Inc. CORPORATE HEADQUARTER DOWNTOWN, 1000 N. 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