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The development of hemodialysis (HD) membranes has substantially advanced in the last decade. This has resulted in the manufacturing of medium cut-off membranes (MCO) whose internal architecture is based on greater pore size and a smaller diameter, thus promoting the clearance of particles of greater size as well as retrofiltration. Multiple studies have proven their efficacy in the clearance of uremic mid-sized molecules such as β2-microglobulin, free light chains, and some interleukins; this clearance is far superior with MCO membranes when compared with high-flux HD, and similar to that obtained with online hemodiafiltration. This review summarizes the results of the most relevant clinical studies of this membrane in terms of uremic toxin clearance, as well as the features of some clinical outcomes such as quality of life and hospitalizations.

Membranes and sorbents play a crucial role in extracorporeal blood purification therapies, which aim to remove harmful molecules and toxins from the blood. Over the years, advancements in hemodialysis (HD) membranes and sorbents have significantly enhanced their safety and effectiveness. This review article will summarize the latest breakthroughs in the development and clinical application of HD membranes and sorbents. We will commence with a concise examination of the mechanisms involved in solute transport across membranes and sorbents. Subsequently, we will explore the evolutionary path of HD membranes, from early cellophane membranes to high-flux membranes, including the development of high-cutoff membranes and the emergence of medium- cutoff membranes. We will discuss each type of HD membrane's advantages and limitations, highlighting the most promising advancements in novel biomaterials and biocompatibility, technologies, research in membrane performance, and their clinical applications. Furthermore, we will delve into the evolution and progress of sorbent technology, tracing its historical development, outlining its key characteristics, examining the mechanism involved in the adsorption process, and exploring its clinical application. This review aims to underscore the growth and future landscape of HD membranes and sorbents in extracorporeal blood purification techniques.

Unassigned: Acute kidney injury (AKI) is common in critically ill patients. There is no specific pharmacological treatment for established severe AKI. Therefore, the conventional therapeutic strategy is limited to the use of kidney replacement therapy (KRT) to maintain homeostasis. Hybrid therapies optimize the advantages of intermittent and continuous modalities of KRT, combining lower hourly efficiency, longer application time, at lesser cost, but also adding different physicochemical principles of extracorporeal clearance. The sum of convection and diffusion, with or without adsorption or apheresis, and in different time combinations gives hybrid techniques great flexibility in prescribing a personalized treatment adapted to the needs of each patient at any given time. Hybrid therapies are increasingly being used due to their flexibility, which is determined by the combination of equipment, membranes, and available resources (machines and health-care personnel experience). The required technology is widely available in most intensive care units and uses low-cost consumables compared to other types of AKI treatment modalities, favoring its widespread use. Hybrid therapies are feasible and provide a viable form of KRT, either alone or as a transition therapy from continuous kidney replacement therapy to intermittent hemodialysis. (Rev Invest Clin. 2023;75(6):337-47)., (Copyright: © 2023 Permanyer.)

Initial reports suggested that kidney involvement after coronavirus disease 19 (COVID-19) infection was uncommon, but this premise appears to be incorrect. Acute kidney injury can occur through various mechanisms and complicate the course of up to 25% of patients with COVID-19 hospitalized in our Institution, and of over 50% of those on invasive mechanical ventilation. Mechanisms of injury include direct kidney injury and predominantly tubular, although glomerular injury has been reported, and resulting from severe hypoxic respiratory failure, secondary infection, and exposure to nephrotoxic drugs. The mainstay of treatment remains the prevention of progressive kidney damage and, in some cases, the use of renal replacement therapy. Although the use of blood purification techniques has been proposed as a potential treatment, results to date have not been conclusive. In this manuscript, the mechanisms of kidney injury by COVID-19, risk factors, and the mainstays of treatment are reviewed.

Background: Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, patients with chronic kidney disease vulnerable to suffering more severe COVID-19 disease and worse outcomes have been identified., Objectives: Our study's aim was to determine the incidence, characteristics, and outcomes of SARS-CoV-2 infection in patients of hemodialysis (HD) units in Mexico and to describe the availability of confirmatory testing., Methods: This study was multicentric study of 19 HD units, conducted between March 2020 and March 2021., Results: From a total of 5779 patients, 955 (16.5%) cases of suspicious COVID-19 were detected; a SARS-CoV-2 reverse transcription polymerase chain reaction test was done in only 50.6% of patients. Forty-five percentages were hospitalized and 6% required invasive mechanical ventilation (IMV). There was no significant difference in mortality between confirmed (131/483) and suspicious (124/472) cases (p = 0.74). The percentage of patients in need of hospitalization, IMV, and deceased was greater than in the rest of the study population., Conclusions: The study revealed that 49.4% of the cases were not confirmed, a worrisome observation given that this is a highly vulnerable population (higher probability of contagion and worse outcomes), in which 100% of patients should have a confirmatory test., (Copyright: © 2022 Permanyer.)

Background: A high incidence of acute kidney injury (AKI) has been reported in coronavirus disease 2019 (COVID-19) patients in critical care units and those undergoing invasive mechanical ventilation (IMV). The introduction of dexamethasone (DXM) as treatment for severe COVID-19 has improved mortality, but its effects in other organs remain under study., Objective: The objective of this study was to evaluate the association between DXM and AKI in COVID-19., Methods: In this prospective observational cohort study, we evaluated the incidence of AKI in critically ill COVID-19 patients undergoing mechanical ventilation, and the association of DXM treatment with the incidence, severity, and outcomes of AKI. The association between DXM treatment and AKI was evaluated by multivariable logistic regression. The association of the combination of DXM treatment and AKI on mortality was evaluated by Cox-regression analysis. Results: We included 552 patients. AKI was diagnosed in 311 (56%), of which 196 (63%) corresponded to severe (stage 2 or 3) AKI, and 46 (14.8%) received kidney replacement therapy. Two hundred and sixty-seven (48%) patients were treated with DXM. This treatment was associated to lower incidence of AKI (Odds Radio 0.34, 95% Confidence intervals [CI] 0.22-0.52, p < 0.001) after adjusting for age, body mass index, laboratory parameters, SOFA score, and vasopressor use. DXM treatment significantly reduced mortality in patients with severe AKI (HR 0.63, 95%CI 0.41-0.96, p = 0.032)., Conclusions: The incidence of AKI is high in COVID-19 patients under IMV. DXM treatment is associated with a lower incidence of AKI and a lower mortality in the group with severe AKI., (Copyright: © 2022 Permanyer.)

Background: Delayed graft function (DGF) is an early complication of kidney transplant (KT) and it is related to a higher incidence of acute rejection (AR) and lower graft survival. The incidence of DGF ranges from 2 to 29% in different series. Several risk factors for DGF have been described, including inotropic use in the deceased donor, long cold ischemia time, cardiovascular brain death, age > 55 years, hypovolemia, previous transplant, preformed antibodies and OKT3 use., Material and Methods: This study is a retrospective cohort of the kidney transplant recipients (KTR) of deceased donors from 1990 to 2009, at the INCMNSZ. We analyzed the incidence of DGF, risk factors associated to its development, and patient and graft outcome. To compare the groups, we used chi2 test or Student's t test for categorical and numeric variables, respectively. Patient and graft survival were calculated using Kaplan-Meier method; a p value < 0.05 was considered statistically significant., Results: Data from 105 KTR were analyzed. DGF occurred in 21%, AR in 27%, graft loss in 15.2%. The only risk factor associated to DGF was brain death due to vascular disease (p = 0.028)., Conclusions: Brain death due to vascular disease was the only risk factor associated to DGF. A non-significant higher incidence of AR was observed in patients with DGF. Survival was significantly lower in patients who developed DGF compared to those without DGF, and it was not related to renal function.

Fabry-Anderson disease is a lysosomal storage disease caused by deficiency of the enzyme alpha-galactosidase. This enzymatic defect results in the accumulation of glycosphingolipid into different lines cells. Usually the deficiency is complete, resulting in a multisystem disorder, with injury in different organs, predominantly heart, kidney and nervous system. However, in some patients the enzymatic deficit is partial and causes diverse clinical variants of the disease (renal or cardiac variety), this cause a difficult diagnostic and the absence of real epidemiology data. This review is about the epidemiology, the metabolic defect of this disease, it's molecular and genetics bases, the different forms of clinical presentation and the enzyme replacement therapy.

Introduction: The recipients of HLA-identical live-donors grafts (RKT 2HP) have a low immunologic risk, and it is common to use immunosuppressive regimen with two medicaments excluding the calcineurin inhibitor. This study compares the long term outcomes of the double immunosuppressive therapy versus the triple therapy in RKT 2HP., Materials and Methods: This study is a retrolective cohort. The patients were divided in two groups: (1) RKT 2HP who receive double immunosupresive therapy and (2) RKT 2HP with triple immunosupresive therapy. The outcomes evaluated were: renal function, acute rejection rate, lost of renal allograft, death rate, infections and hospitalization, change in the immunosupresive therapy and its causes., Results: We analyzed 85 kidney transplant recipients who share two haplotypes, 60 in the group 1 and 25 in the group 2. The median of time of follow-up in the group 1 was 138 months (min 23 and max 302) and 55 months (min 12 and max 106) in the group 2. There were four cellular acute rejection and nine allograft lost in patients of the group 1. There wasn't any significant difference between the allograft outcome and the renal function at 60 months of follow out between the groups. 23 patients had change in the immunosuppressive therapy, 12 (53%) in the group 1 and 11 (47%) in the group 2. The major cause of change of therapy in the group 1 was leucopenia by azatioprin (five patients); and in the group 2 was nephrotoxicity for calcineurin inhibitor (six patients)., Discussion: Despite the evident nephrotoxicity, the use of calcineurin inhibitor is useful even in patients with low immunologic risk. According to the time of follow-up between the groups, even when the allograft survival was superior in group 2, the difference wasn't significative, it might be because the lower number of patients in group 1.

Introduction: Addition of anti-IL2r monoclonal antibodies (chimeric or humanized) for induction therapy has reduced the frequency of acute rejection (AR). This study compares the impact of type and dosage of induction therapy on frequency of acute rejection and on renal function during the first year post-transplant., Patients and Methods: Comparative retrospective study. Kidney transplant recipients (KTR) were divided in three groups according to induction therapy, as follows: (1) Basiliximab in two 20 mg doses, (2) Daclizumab 2 mg/kg in one dose, and (3) Daclizumab 2 mg/kg divided in two doses (1 mg/kg each). Groups were paired for age, sex, number of shared haplotypes, and previous transplant history. Primary endpoints were AR episodes, time to first AR, graft loss, and death. Secondary endpoints were SCr (at 3, 6, 9 and 12 months), frequency and type of infection, and cost., Results: There were no baseline differences between groups. Twenty one patients were included in each group. The incidence of AR was similar: 14.2% in group 1, and 9.5% for groups 2 and 3. Two deaths were reported, one in group 1 and another in group 2. Mean SCr was similar between groups. Incidence of infection was 6, 5, and 7 in groups 1 to 3, respectively without a significant difference. The cost was higher in group 1 (p < 0.001)., Conclusion: Low dose Daclizumab in one or two doses is equally effective and safe as basiliximab at 12-month follow-up, with inferior cost.

Background: The prognosis and outcome in patients with end stage renal disease is significantly related to the predialysis care and early or late nephrological referral. Late nephrological referral has been associated with more hospital admissions and mortality at six months after the dialysis was initiated. We lack information about the role of early nephrological referral and its impact in biochemical variables and first hospitalization in our country., Methods: The charts of all patients that were admitted to peritoneal dialysis in the period 01/1999-06/2001 were reviewed. We divided the population in group A with patients referred to nephrologist more than 3 months before the start of dialysis (early referral) and group B with those patients referred for a period shorter than three months or no referred before the start of dialysis (late referral or no referral). The patient's characteristics, laboratory values, characteristics of the first hospitalization and drugs were analyzed when dialysis was initiated and after six months of follow-up., Results: Patients in group A were older and the percentage of patients with diabetes and hypertension was higher. The patients with early referral started dialysis with higher levels of hemoglobin (9.2 vs. 8.3 g/dL, p = 0.01) and with lower serum levels of BUN (91 vs. 122.5 mg/dL, p = 0.0001), creatinine (8.4 vs. 12.8 mg/dL, p = 0.0002) and phosphorus (6.4 vs. 7.7 mg/dL, p = 0.01). The length of the first hospitalization was shorter in patients of Group A (5.7 vs. 10.5 days, p = 0.004) and the emergency department was less used to peritoneal catheter placement in this group (46.3 vs. 86.9%, p = 0.01). There were not differences in hospitalization between the two groups after six months., Conclusion: Patients with early referral to a nephrologist show better biochemical variables, shorter first hospitalization length and higher percentage of elective placement of catheter.