Application Of Hybrid Blood Purification Technology in Severe Acute Kidney Injury

The prevalence of acute kidney injury (AKI) in critically ill patients is 30% to 50%, and about 2 million people worldwide die of AKI every year. Patients with critically ill AKI often have sepsis, respiratory failure, liver failure, and heart failure, and thus require multiple organ function supportive treatment. Hybrid blood purification technology plays an important role in multiple organ function support therapy.

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In a narrow sense, hybrid blood purification technology refers to prolonging low-efficiency daily dialysis. In a broad sense, it refers to the synchronous or sequential combination of two or more basic blood purification modes. Treatment modes include prolonging low-efficiency daily dialysis, continuous intravenous- Venous hemodiafiltration, continuous renal replacement therapy (CRRT) + hemoperfusion/plasma exchange, continuous plasma filtration adsorption, CRRT + plasma adsorption, dual plasma molecular adsorption system, Prometheus system, molecular adsorption recirculation system and CRRT + extracorporeal carbon dioxide Clear technology (ECCO2R), etc.

The clinical application of blood purification technology is becoming more and more extensive. In addition to acute and chronic renal failure, it is also widely used in various poisons and drug poisoning, respiratory and liver function support, homeostasis, and various organ function support. For AKI, continuous low-efficiency dialysis can meet the needs of solute removal and fluid control, and improve the prognosis of AKI patients. In terms of acute severe poisoning, blood purification can improve the prognosis of patients by effectively removing toxins/poisons. For mushroom poisoning and paraquat poisoning, CRRT+hemoperfusion is recommended for treatment, and arsenic hydrogen poisoning, CRRT+plasma exchange is recommended.

The most common cause of hyperammonemia in adults is liver failure. The indication for CRRT treatment is blood ammonia > 200 μmol/L after traditional treatment, continuous venovenous hemodiafiltration mode, early high-dose [dialysate flow rate 5000 ml/h, replacement fluid flow rate 90 ml/(kg h)] until blood ammonia <100 μmol/L, and then maintenance therapy [dialysis fluid flow rate 500 ml/h, replacement fluid flow rate 35 ml/(kg h)].

In terms of respiratory failure, to avoid ventilator-associated lung injury, small tidal volume ventilation is recommended, but small tidal volume ventilation may lead to CO2 accumulation and secondary hypercapnia. ECCO2R can make up for this deficiency. ECCO2R on-board indications are PCO2>60 mmHg (1 mmHg=0.133 kPa), pH<7.25, respiratory rate>20 times/min, PaO2/FiO2<150 mmHg and positive end-expiratory pressure ventilation>8 cmH2O; stop indication It is pH > 7.30 and respiratory rate < 25 breaths/min for at least 12 hours.

In terms of septic shock, blood purification therapy is an important treatment for septic AKI. At present, the commonly used methods include high-volume hemofiltration, plasma exchange, perfusion adsorption, etc., to remove damage-related molecules and remove etiology-related molecules to improve abscess. Prognosis of Toxic Patients.

In terms of new coronavirus pneumonia, new coronavirus pneumonia can cause an "inflammatory storm" and lead to multiple organ failure, while hemoperfusion/CRRT can reduce an "inflammatory storm" and rebuild "inflammatory homeostasis". my country's "Diagnosis and Treatment Program for Novel Coronavirus Pneumonia (Trial Eighth Revised Edition)" and "Expert Consensus on the Application of Special Blood Purification Technology in Severe Novel Coronavirus Pneumonia" both pointed out that blood purification can block the "inflammatory storm" and can be used for severe cases. , Early and mid-term treatment of critically ill patients with "inflammatory storm".

To sum up, patients with critically ill AKI need multiple organ function supportive treatment including kidney, respiration, and liver. Hybrid blood purification has been widely used in AKI, drug and poison poisoning, respiratory failure, liver failure, septic shock, etc., which helps to improve the success rate of rescue in critical cases.

How does Cistanche treat kidney disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.