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Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration01:25

Extracorporeal Removal of Drugs: Hemoperfusion and Hemofiltration

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Hemoperfusion and hemofiltration are critical techniques in medical treatments to eliminate accumulated drugs, metabolites, and electrolytes from the bloodstream. These methods are particularly vital in cases of accidental poisoning and drug overdose.Hemoperfusion involves passing blood through an adsorbent material to remove unwanted substances. The main adsorbents used in hemoperfusion include activated charcoal and Amberlite resins. Activated charcoal can adsorb both polar and nonpolar...
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Once the process of glomerular filtration is completed, blood carrying unfiltered drug molecules traverses through efferent arterioles and makes its way into the peritubular capillaries in the proximal tubule. A variety of carriers play a pivotal role in actively secreting drugs from these peritubular capillaries into the tubular fluid. The organic anion transporter transfers acidic drugs, against an electrochemical gradient, from the peritubular capillaries into the renal tubule cells and...
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Patients with end-stage renal disease (ESRD) or those experiencing drug overdose often require extracorporeal methods to eliminate accumulated drugs and metabolites. Hemoperfusion, hemofiltration, and dialysis are the primary techniques to rapidly remove harmful substances without disrupting the patient's fluid and electrolyte balance. For those with compromised renal function, dosage adjustments of concurrent medications may be necessary during extracorporeal drug removal.Dialysis is a process...
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Pore transport and ion-pair formation are critical mechanisms for the absorption and distribution of drugs in the body.
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Dialysis is a diffusion-based purification process that separates analyte molecules from a complex matrix. This is accomplished by allowing molecules in the solution to pass through a semipermeable membrane into a liquid on the other side. The membrane is usually made of cellulose acetate or cellulose nitrate, and the second liquid must be miscible with the solution. Ions (e.g., chloride or sodium) or organic molecules (e.g., glucose) can pass through the membrane pores, which generally have...
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Drug transporters are critical in drug absorption, distribution, and excretion processes. They should be included in physiological-based pharmacokinetic (PBPK) models, which help predict human drug disposition. However, predicting this is challenging during drug development, especially when liver transport is involved. However, with a realistic representation of body transport processes, an accurate model may be possible.
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Polymyxin B hemoperfusion: a mechanistic perspective.

Claudio Ronco, David J Klein

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    Summary

    Direct hemoperfusion using polymyxin B immobilized fiber (PMX-DHP) effectively removes endotoxins in septic shock patients. This therapy improves organ function, hemodynamics, and reduces mortality, offering a targeted treatment strategy.

    Area of Science:

    • Critical Care Medicine
    • Nephrology
    • Immunology

    Background:

    • Sepsis and septic shock are life-threatening conditions often associated with endotoxemia.
    • Polymyxin B immobilized fiber (PMX-DHP) therapy is an established treatment in some regions for septic shock.
    • The EUPHRATES trial is investigating PMX-DHP in North America for septic shock with confirmed endotoxemia.

    Purpose of the Study:

    • To review the mechanistic rationale for PMX-DHP in endotoxemic septic patients.
    • To highlight the specific effects of PMX-DHP therapy on endotoxin and cytokine levels.
    • To present evidence of clinical improvements in organ function and mortality.

    Main Methods:

    • Review of existing clinical and basic research on PMX-DHP therapy.
    • Analysis of endotoxin removal efficacy by PMX-DHP.

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  • Examination of effects on cytokine levels, apoptosis, and organ function.

    • Main Results:

    • PMX-DHP can reduce circulating endotoxin levels by up to 90%.
    • Studies show reductions in circulating cytokines and renal tubular apoptosis.
    • Clinical data indicate hemodynamic and oxygenation improvements, enhanced renal function, and reduced mortality.

    Conclusions:

    • PMX-DHP is a targeted therapy for endotoxemic septic patients.
    • The therapy demonstrates significant potential for improving clinical outcomes in septic shock.
    • Further research is needed to optimize its use and identify broader patient populations.