Journal of Japan Society for Blood Purification in Critical Care
Online ISSN : 2434-219X
Print ISSN : 2185-1085
Volume 6, Issue 1
Displaying 1-20 of 20 articles from this issue
  • Tatsuo Tsukamoto, Atsumi Yamada, Megumi Iida, Masanori Anma, Motoko Ya ...
    2015 Volume 6 Issue 1 Pages 3-9
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    Herein, we describe the recurrence prevention measures and challenges for a serious medical accident caused by a mix-up in blood purification columns at Kyoto University Hospital in November 2011. Investigation committees have identified several problems to be solved, and we have implemented recurrence prevention measures including (1) the establishment of continuous hemodiafiltration (CHDF) circuit assembly by a clinical engineer (CE) all day; (2) the separation of CHDF order into materials and configurations; (3) device management; (4) the integrative renewal of operation procedures on CHDF and plasma exchange and the unification of operation procedures among intensive care units; (5) the provision of continuous education for nurses and the authorization of a certified blood purification nurse; and (6) the reinforcement of the care system between the blood purification center and other departments. In order to prevent another fatal error through education, we have offered several courses to enable both duty CEs and nurses to enhance their blood purification skills. We have also authorized a certified blood purification nurse who has passed an examination. Despite these measures, we continue to face problems that cannot be solved easily. For example, the shape of blood purification columns, such as blood ports and dialysate ports, is standardized and, as such, it is impossible to prevent the error from recurring. The setting display also differs for each CHDF device, leading to improper operation and accidents. The cooperation of the relevant manufacturers is essential to the further improvement of recurrence prevention measures and proposals.

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  • Makoto Takatori
    2015 Volume 6 Issue 1 Pages 10-16
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    The stability of circulation and the recovery of the renal function are the main goals of blood purification in the acute critically ill setting. For this purpose, both the continuity and adjustability regarding the purification of dialysis water are necessary to apply the technique of on-line HDF. In our ICU, the on-line CHDF system consists of a dialysis machine and an RO module, where the system is used either continuously or sometimes is shut down for long periods of time. The water quality is maintained by sterilization of the dialysate lines, the aseptic manipulation of the circuits, and programmed cleaning and rinsing at times when this system is not in use. The deposition of calcium carbonate is a major problem associated with the continuous use of the dialysate machine. We therefore established limits in the running time, and an effective protocol for acid-rinsing using an increased concentration of acetate. We have so far experienced few problems with these protocols, however, further improvements are needed for the continuous use of the dialysis machines. A high degree of adjustability is obtained with the disposable special circuit, while the dialysate and substitute flow is optimized for each individual patient. Moreover, the greatest advantage of this system is the fact that this system can deliver very high doses of dialysate and substitution fluid if necessary, and this system is not associated with any increases in either medical costs or manpower.

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  • Tatsuhide Azuma, Masanori Abe, Kazuyoshi Okada, Tetsuya Furukawa, Masa ...
    2015 Volume 6 Issue 1 Pages 17-22
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Purpose】This study aimed to determine the effects of frequent low-efficiency and short hemodialysis(FLESHD)in comparison with frequent low-efficiency and short hemofiltration (FLESHF) in hemodialysis (HD) patients with acute brain injury (ABI).【Methods】We randomly divided 14 HD patients with ABI into the FLESHD (n=7) or FLESHF (n=7) group. Conditions for the first to third sessions were as follows. FLESHD: intravenous administration of glycerol 400 mL/session, blood flow rate (QB) 100 mL/min, dialysate flow rate 300 mL/min, and duration 2 h. FLESHF: intravenous administration of glycerol 400 mL/session, QB 150 mL/min, substitution flow rate 10 L/session, and duration 4 h. Conditions were gradually changed from the fourth session onward.【Results】There were no significant differences in survival rate, consciousness level, or adverse effects during hospitalization between the groups. Additionally, no significant differences were seen in the levels of osmolality, blood pressure before and after treatment, or in the level of HCO3 before treatment. However, the level of HCO3 after FLESHD was significantly lower than that after FLESHF, and extracorporeal circulation time was significantly shorter in the FLESHD group.【Conclusions】FLESHD with glycerol under these conditions may be a better therapeutic option for managing patients with ABI.

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  • Takehiro Miyasaka, Taisuke Murakami, Kouji Inoue, Satoshi Saeki
    2015 Volume 6 Issue 1 Pages 23-28
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    The outer diameters for vascular access catheters can range between 11-13 Fr. These sizes are relatively large when inserted into, for example, the jugular vein and may hinder the venous bloodstream in various degrees. In addition, because the lumen within the catheter is quite narrow, the actual blood removal rate may be lower than that indicated on the pump, possibly affecting treatment adversely. In this study, various catheters of different sizes were inserted into simulated veins. The blood flow rates within the simulated veins before and after catheter insertion were measured. In addition, the lumen blood removal flow rates were measured and compared with the indicated rates, along with any drop in blood pressure. The results showed a drop in the venous flow rate of as much as 15%, with an average drop of about 10%. The actual blood removal flow rates from the simulated veins were lower than that indicated on the pumps, and the difference in these two rates became increasingly larger as the indicated flow rates were increased. Any drop in blood pressure was linked to the tip and cross-sectional shapes of the catheters. In conclusion, this study clearly shows that there is a discrepancy between the actual blood removal rate and the indicated rate when using catheters for removing and treating blood, and that the catheters inserted into the simulated veins influence the actual flow rate.

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  • Yoshimitsu Takahashi, Junichiro Kazama, Fujio Nakamura, Toshikazu Ikom ...
    2015 Volume 6 Issue 1 Pages 29-34
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    Vascular access hemodialysis catheters (catheters) are mainly used for rapidly and safely hemodialysis therapy. But we often encounter that the dialysis should be stopped by suction towards the vessel wall of the vascular access hemodialysis catheters. We established an ex vivo evaluation system for quantifying the efficiency of catheters as it is difficult to evaluate at clinical level. Venous blood vessels of pigs were connected to the system, and pig blood was circulated in the rate of 100~300mL/min. We inserted a catheters in the blood vessel and the blood flow quantity (Qb) was set in 100~200mL/min. Suction towards the vessel wall occurred at both Qv 300mL/min, and Qb 100~300mL/min in end hole type of catheters. On the other hand, using side hole type of catheters, suction towards the vessel wall didn’t occur at Qv 300mL/min, Qb 100 and 150mL/min, but occurred at 20%, at Qb 200mL/min. A new system of experimental extracorporeal circulation allows us to evaluate quantitatively the efficiency of catheters.

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  • Kana Yakushinji, Norihisa Yasuda, Kouhei Ono, Takayuki Mizoguchi, Tats ...
    2015 Volume 6 Issue 1 Pages 35-39
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Objective】 In this study, we examined whether high-flow volume-continuous hemodiafiltration (HFV-CHDF) can be performed safely with CH-1.8W or UT-2100S hemofilters for 24h in our intensive care unit. We compared the transmembrane pressures (TMP) at onset of CHDF and the time course-associated changes in TMP with CH-1.8W and UT-2100S hemofilters. 【Materials and methods】 The subjects included patients who underwent HFV-CHDF between April and May 2014. HFV-CHDF was performed as follows: QB, 100 mL/min; QD, 900 mL/h; and QF, 900 mL/h. The time course-associated changes in TMP during CHDF and rate of discontinuation of CHDF due to coagulation in the hemofilter were retrospectively investigated. HFV-CHDF was performed with a CH-1.8W hemofilter (CH-1.8W group) or UT-2100S hemofilter (UT-2100S group). 【Results】 The rate of discontinuation of CHDF due to coagulation was comparable in the CH-1.8W and UT-2100S groups. The mean TMP at the onset of CHDF was markedly higher in the CH-1.8W group compared with the UT-2100S group. In addition, the time course-associated changes in TMP were higher in the CH-1.8W group compared with the UT-2100S group. Both CH-1.8W and UT-2100S hemofilters comparably performed HFV-CHDF. 【Conclusion】 TMP was higher in the CH-1.8W group compared with the UT-2100S group because of differences in the membrane structures and properties. However, the lifespan of CH- 1.8W and UT-2100S hemofilters were comparable, and both hemofilters safely performed HFV-CHDF for 24h.

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  • Masao Iwagami, Kent Doi, Hideo Yasunaga, Eisei Noiri
    2015 Volume 6 Issue 1 Pages 40-45
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    The purpose of the research was to compare the characteristics and in-hospital mortality of septic and non-septic acute kidney injury (AKI), using the Japanese Diagnosis Procedure Combination Database in 2011. Adult patients starting acute renal replacement therapy (RRT) in intensive care units were classified into septic AKI and non-septic AKI groups. We compared age, sex, duration between admission and RRT initiation, RRT modality, treatment regimens on the day of RRT initiation, and hospital characteristics, as well as in-hospital mortality of the septic and non-septic AKI groups. Kaplan-Meier survival curves were illustrated. Multivariable logistic regression analysis was performed to estimate odds ratio (septic AKI versus non-septic AKI) for in-hospital mortality. Among 7,353 eligible patients, 2,523 (34.3%) were in the septic AKI group. Patients with septic AKI were slightly older, while the male proportion was smaller. Septic-AKI patients were more likely to receive continuous RRT and severe treatment regimens. In-hospital mortalities were 53.6% (1,353/2,523) and 42.2% (2,038/4,830), in the septic and non-septic AKI groups, respectively (P<0.001). Adjusted odds ratio for in-hospital mortality was 1.212 (95% confidence interval; 1.086-1.353). In conclusion, patients with septic AKI were more severe and had a higher mortality rate than those with non-septic AKI. In addition, septic AKI was independently associated with increased mortality.

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  • Masashi Morizane, Hiroyuki Nagafuchi, Hidenori Suzuki, Mayuka Handa, R ...
    2015 Volume 6 Issue 1 Pages 46-51
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Objective】Focusing on pediatric acute liver failure (ALF) patients weighing 10~15 kg, we evaluated the relationship between clearance (CL), membrane area (MA) per blood flow (QB), and dialysate flow rate (QD) in vitro. 【Material and methods】 We calculated CL and mass balance error (%MBE) in the setting of hemofilters sized 0.3 m2 and 0.7 m2 (AEF-03, AEF-07), QB (20, 40, 80 mL/min), and QD (20, 40, 80 mL/min). Index substances included urea (UN), creatinine (Cr), inorganic phosphorus (IP), and vitamin B12 (VB12). The experimental system was an aqueous solution system, a continuous hemodialysis single pass circuit. 【Result】 The CL material from the small molecular weight group (UN, Cr, IP) depended on QB and QD but not MA. CL of the middle molecular weight material (VB12) depended on QD and MA with a constant QB. The %MBE from all the results was under 30%. 【Conclusion】 CL of the small molecular weight material depended on QB and QD rather than MA, but it was observed that CL of the middle molecular material, assumed to be a target material for acute liver failure, increased with MA. In pediatric ALF, patients weighing 10~15 kg, changing the MA from 0.3 m2 to 0.7 m2 may become advantageous in efficiently removing middle molecular weight materials and the coming out of a hepatic coma.

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  • Joe Yoshizawa, Koichiro Homma, Masaru Suzuki, Junichi Sasaki, Jun Nami ...
    2015 Volume 6 Issue 1 Pages 52-57
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Background and Objective】 No report has detailed the proportion of patients who receive acute blood purification therapy after being taken to the hospital for emergency medical care in Japan. Therefore, in this study, we examined how often acute blood purification was performed at our hospital. 【Methods】 We investigated how frequently hemodialysis, hemodiafiltration, and continuous hemodiafiltration were required by patients urgently admitted to our hospital during the 24 months from August 2008 through July 2010. 【Results】 Of the patients brought by ambulance and admitted for urgent medical care, 3.9% underwent hemodialysis or hemodiafiltration, and 2.1% underwent continuous hemodiafiltration. Therefore, 6.0% of all emergency patients underwent acute blood purification. 【Conclusion】 Acute blood purification was conducted in 6.0% of inpatients who were brought to our hospital for urgent care. This showed that such treatment is essential for ensuring the provision of high-quality emergency medical care.

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  • Tomoki Okajima, Ryoichi Sakiyama, Takayuki Abe, Isamu Ishimori, Jun Mu ...
    2015 Volume 6 Issue 1 Pages 58-62
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    Blood purification dialyzers that use polymethyl methacrylate (PMMA) mainly remove several medium and large molecular substrates by membrane adsorption; their characteristics are particularly effective for continuous blood purification therapy. Recently, a PMMA membrane dialyzer with a modified membrane surface, NF-1.0H, has been introduced to improve antithrombogenicity. In this study, NF-1.0H was compared with BG-1.0PQ and CH-1.0N with conventional PMMA membrane in terms of clearance values for urea, β2-microglobulin, α1-macroglobulin, and albumin, under a blood flow rate of 100mL/min; dialysate flow rate of 500 mL/h; and filtration flow rate of 1,000 mL/h. Human plasma harvested from plasma exchange treatments was used as a blood-side solution at recirculation mode and sublood-BSG was used as dialysate at a single-pass mode. The results showed that clearances of β2-microglobrin, α1-microglobrin, albumin and IL-6 in NF-1.0H were no significant difference among the dialyzers. Although it had higher antithrombogenicity, the membrane adsorption property of NF-1.0H was similar with other PMMA dialyzers. A filter with a longer lifetime would be required for acute blood purification in the near future.

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  • Sumi Hidaka, Yasuhiro Mochida, Kyouko Maesato, Kunihiro Ishioka, Machi ...
    2015 Volume 6 Issue 1 Pages 63-66
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    A 50 year-old woman who perspires heavily for three years was admitted for severe edema, serous diarrhea and dyspnea. Blood test and X-ray scanning revealed severe hyperthyroidism and cardiac enlargement with massive pleural effusion. We diagnosed thyroidal crisis. She became the cardiopulmonary arrest during clinical examination, we started cardiopulmonary resuscitation immediately. Her heart beat recovered quickly but her hemodynamics did not recover. We treated her with intra-aortic balloon pumping and percutaneous cardio pulmonary support, however, blood pressure (BP) still showed very low level. We started plasma exchange (PE) and continuous hemodiafiltration in order to remove excessive thyroid hormones. The serum levels of thyroid hormones decreased and systemic vascular resistance index and BP increased significantly during the first session of PE. PE has a remarkable effect on the removal of thyroid hormones in patient with severe thyroid crisis.

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  • Yuji Yamagami, Satoru Chujoh, Tadamori Takahara, Takenori Suga, Hikoak ...
    2015 Volume 6 Issue 1 Pages 67-70
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    Since the introduction of plasma exchange (PE) therapy in children in December 2007, we experienced 63 children requiring PE therapy (male: female, 41: 22; mean age, 29.5±20.1 months) up to August 2013. Among these children, PE therapy was undertaken in 51 children (80%) with Kawasaki disease, and the other diseases requiring PE therapy were fulminant hepatitis, multiple organ failure accompanied by sepsis, and juvenile idiopathic arthritis. PE therapy was performed 4.0±1.2 times per child, with a mean maximum blood flow rate of 60.0±13.3 mL/min. Many of the pediatric-specific problems found through accumulated cases have been overcome, and the current method of performing PE therapy allows better vascular access, priming of the circuit, anticoagulant administration, sedation, etc. The use of PE therapy and the number of diseases in which it is being used have increased annually. Through our experiences, we aim for safer and faster PE therapy.

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  • Hiroshi Adachi, Kohei Yoshimoto, Noriko Usumoto, Katsuhiko Ayukawa
    2015 Volume 6 Issue 1 Pages 71-73
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Case】An 82 year-old woman with bronchial asthma was transferred to our hospital following an asthma attack. Her serum electrolytes showed slight hypokalemia (3.4 mEq/L) on admission and her serum theophylline concentration (STC) was 33.7μg/mL. Torsade de Pointes (TdP) and ventricular fibrillation (VF) developed soon after she was hospitalized, and they did so again 11 hours later. Serum electrolytes revealed hypokalemia (3.0 mEq/L), with STC decreased to 19.8μg/mL, and Corrected QT Interval (QTc) in electrocardiogram at 483 msec. We then performed direct hemoperfusion (DHP) and continuous hemofiltration (CHF). After performing continuous DHP for 4 hours, STC decreased to 5.9μg/mL. We performed CHF alone for 2 days after finishing DHP, and STC decreased to 2.3μg/mL. The ventricular arrhythmia disappeared after we performed DHP, and hemodynamics stabilized at that time. 【Conclusion】 In this case, though the patient’s condition interacted with acute theophylline intoxication, hypokalemia, and QT prolongation to cause potentially lethal arrhythmia as a poisoning symptom, DHP and CRT proved to be effective treatment.

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  • Mariko Sawada, Kayo Ogino, Tomohiro Hayashi, Masumi Saito, Shinichi Wa ...
    2015 Volume 6 Issue 1 Pages 74-77
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【BACKGROUND】 The long-term renal outcome in infants after acute kidney injury (AKI) remains unclear. We report the case of an infant with chronic renal tubular injury after AKI. 【CASE】 An 18-day-old male with acute cellulitis of the heel was admitted to hospital. Antibiotics were administered. On day 27, an abscess and osteomyelitis developed, and surgical drainage was performed. On day 28, he presented with hemorrhagic shock because of bleeding from the drainage. He was transferred to our hospital. He presented lethargy, oliguria, hyperkalemia and coagulation disorder. There was no arrhythmia and electrocardiogram was normal; insulin-glucose therapy was initiated. His circulatory condition stabilized however, he presented with hyperkalemia and oliguria; both improved promptly following blood purification therapy from day 29 for two days. His glomerular injury improved within one month, but the tubular injury persisted. Hyponatremia developed due to the increase in urinary sodium excretion, and sodium chloride was administered. His tubular injury persisted without administration of sodium chloride at 3 years old. 【CONCLUSIONS】 Renal function in infancy is maturing, and assessment of renal function after AKI is difficult. We need to establish a long-term follow-up system for children with severe AKI.

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  • Minako Akiyama, Hiroshi Yoshimoto, Naoko Igarashi, Yoko Endo, Shigeki ...
    2015 Volume 6 Issue 1 Pages 78-81
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    【Case】 A 58-year-old man who was diagnosed as having IgM κ-type Waldenström macroglobulinemia (WM) has treated with maintenance hemodialysis due to rapidly progressive kidney failure and peripheral neuropathy secondary to paraproteinemia. Chemotherapy according to the R-CHOP schema was initiated for WM, but interstitial pneumonia occurred as an adverse effect. Chemotherapy was stopped, but the hemodialysis was continued to eliminate free light chains (FLCs. 【Methods】 To determine the most effective FLC elimination method, hemodialysis was performed for this patient under several conditions by changing the kinds of dialyzers and dialysis methods. The removal rate, removal amount, and clear space of FLCs were then evaluated. 【Results】 The condition that showed the highest FLC removal rate was hemodiafiltration with a V-type membrane. Significant correlations were found between removal rates of κ light chain and β2-MG, and between removal rates of λ light chain and α1-MG (r=0.943 [p=0.035] and r=0.943 [p=0.035], respectively). Meanwhile, hemodialysis with the PMMA membrane showed the highest removal amount and clear space of FLCs. However, a large amount of albumin was also eliminated. 【Summary】 In conclusion, PMMA and V-type membranes, which have excellent propensities for molecular elimination were considered to be better than other membranes for FLC removal. However, a large amount of albumin tended to be eliminated using these membranes. When choosing the dialysis conditions for patients with WM, it seems important to consider their general condition, including their nutritional status. Further studies are necessary to identify the best method for FLC elimination in patients with WM.

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  • Hirotaka Sawano, Keisuke Oyama, Yuichi Yoshinaga, Tomoaki Natsukawa, Y ...
    2015 Volume 6 Issue 1 Pages 82-85
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    We report the case of a patient with severe respiratory failure as a result of pneumonia caused by influenza virus that was managed with extracorporeal membrane oxygenation (ECMO). We performed fluid control with continuous hemodiafiltration (CHDF) to manage extravascular lung water (EVLW) and pulmonary vascular permeability index (PVPI). A 50-year-old man with severe respiratory failure was transferred to our hospital after failure of treatment with conventional ventilator management. ECMO was introduced immediately because highly diffuse infiltration shadows were observed on the chest X-ray and PaO2/FiO2 was significantly decreased (79.3). We detected influenza A/H1N1pdm09 in his bronchial lavage fluid and administered intravenous peramivir. A transpulmonary thermodilution monitoring system showed EVLW of 32 mL/kg and PVPI of 6.7; on the basis of these parameters, we diagnosed severe lung edema with marked pulmonary hyperpermeability. As a result of daily fluid removal by CHDF with EVLW and PVPI monitoring, lung permeability and oxygenation gradually improved. ECMO was discontinued on the 39th day of hospitalization, and the patient was discharged from the hospital on the 96th day. Management of long-term ECMO and strict body fluid control by CHDF were effective in improving the severe pulmonary lesions. EVLW and PVPI were suggested as parameters to determine the necessary fluid removal volume, even in ECMO setting.

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  • Eiichi Sato, Daisuke Matsumura, Mayumi Nomura, Mayuko Amaha, Keiichi I ...
    2015 Volume 6 Issue 1 Pages 86-89
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    A 79-year-old male visited the local clinic to consult about dyspnea, but was transferred to our hospital because of respiratory failure. On arrival, the patient had a consciousness level on the Japan Coma Scale (JCS) of 100, blood pressure 110/80mmHg, pulse rate 116/min, and SpO2 60% in room air. Blood tests showed a white blood cell (WBC) count of 23,200/μL, C-reactive protein (CRP) levels of 21.15 mg/dL, an estimated glomerular filtration (eGFR) rate of 124 mL/min/1.73m2, and KL-6 levels of 666 U/mL. Chest computed tomography (CT) revealed extensive consolidation and ground-glass opacity in both lungs. The patient was diagnosed with acute interstitial pneumonia, and steroid therapy was started. However, polymyxin B immobilized fiber column direct hemoperfusion (PMX-DHP) therapy was performed for 6 hours on both the 4th and the 5th hospital day because of persistent respiratory failure. The PaO2/FiO2 (P/F) ratio improved from 67 to 165 on the 7th day, but respiratory failure progressed because of bilateral pneumothorax, and the patient died on the 20th day. No change in eGFR occurred during treatment. Before PMX-DHP, urinary L-type fatty acid binding protein (L-FABP) was 104.3 μg/g.Cre., declining to 40.8 μg/g.Cre. on the 7th day due to oxygenation improvement, and then rising again to 314.6 μg/g.Cre. on the 15th day with the progression of respiratory failure. Serum lactate levels exhibited the same behavior as urinary L-FABP. The authors propose that circulatory disorders induced by respiratory failure may lead to proximal tubule injury.

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  • Jun Kaminohara, Makoto Takatori
    2015 Volume 6 Issue 1 Pages 90-91
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    IL-6 is one of the major cytokines which increases in blood during the early phase of sepsis. The concentration of IL-6 is directly associated with the severity of sepsis and patient’s fatality. We measured the IL-6 concentration in a septic patient by IL-6 STICKELISA® manufactured by TORAY. The patient was a 67-year-old woman brought to our department with the chief complaints of coma and she had milky white color bacteriuria. Her serum level of BUN was 116 mg/dL and that of Cr was 2.63 mg/dL. Her blood pressure was too low to measure, so we began a continuous intravenous infusion of noradrenaline and administered meropenem. We measured the concentration of IL-6 when the patient entered the ICU. It was higher than 5,000 pg/mL so we started CHDF. Twenty seven hours later, we measured the IL-6 concentration for a time and it was lower than 1,000 pg/mL. The patient was taken off CHDF and vasopressors on the fifth day and she was discharged on the six day. IL-6 STICKELISA® is a semi-quantitative colorimetric analysis. It allows for the rapid detection of the IL-6 concentrations in patient samples and we were able to diagnose hypercytokinemia immediately. Thus, IL-6 STICKELISA® is a useful tool for the measurement of IL-6 concentration, leading to the rapid initiation of therapeutic intervention.

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  • Hajime Nakae
    2015 Volume 6 Issue 1 Pages 92-96
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    Plasma exchange (PE) involves the removal of separated plasma and subsequent infusion of the same amount of plasma fraction or fresh frozen plasma. PE is used to eliminate pathogenic substances. However, some adverse effects have been reported, including hypernatremia, metabolic alkalosis, citrate poisoning, and abrupt changes in the colloid osmotic pressure. To minimize such adverse effects, PE is combined with hemodiafiltration or albumin dialysis therapy in medical institutions. In the interactive session in 2014, there remains much room for discussion about the clinical indication, type and duration of PE, choice of replacement solution, etc. To perform PE in a standardized manner, such project should be discussed in the interactive session of the conference.

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  • Masamichi Shibata, Tetsuya Ogawa, Toshimichi Kobayashi, Yoshihiro Kawa ...
    2015 Volume 6 Issue 1 Pages 97-101
    Published: June 01, 2015
    Released on J-STAGE: May 10, 2022
    JOURNAL FREE ACCESS

    In extracorporeal circulation during blood purification therapy, there is the risk of bleeding, etc., due to constant aeration and circuit breaks, and in continuous blood purification therapy, which requires long-term treatment, the risk increases further, so initiatives addressing risk management and safety management are both necessary and important. This time, we launched minor medical-error reporting system including analysis. Comprehensive education of the medical staff on medical safety is essential, and it is important to consider, regardless of how widely this is carried out, whether or not it is merely for form’s sake and without substance.

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