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Article ; Online: Hemoperfusion in COVID-19.

Lertussavavivat, Tanat / Srisawat, Nattachai

2023 Volume 200, Page(s) 192–200

Abstract: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global emergency outbreak disease that devastatingly affected world public health and the economy. The pathogenesis of severe SARS-CoV-2 infection in humans has been linked ... ...

Abstract	The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the global emergency outbreak disease that devastatingly affected world public health and the economy. The pathogenesis of severe SARS-CoV-2 infection in humans has been linked to a strong immunological response that leads to a hyperinflammatory state, or "cytokine storm," which is a sepsis-like state resulting in capillary leakage, microvascular and macrovascular thrombosis, and multiple organ destruction. In recent years, there have been several case series and few randomized controlled trials studying the effectiveness and risk of various hemoperfusion techniques in the context of severe SARS-CoV-2 infection including HA330, CytoSorb, Polymyxin, oXiris, and Seraph 100 cartridges. Because inconsistencies exist between studies, there is currently no consensus regarding the use of hemoperfusion in patients with SARS-CoV-2 infection. Further well-designed research is needed to validate its potential clinical benefits and identify the timing and characteristics of patients who might benefit the most.
MeSH term(s)	Humans ; COVID-19/therapy ; SARS-CoV-2 ; Hemoperfusion
Language	English
Publishing date	2023-06-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ISSN	1662-2782 ; 0302-5144
ISSN (online)	1662-2782
ISSN	0302-5144
DOI	10.1159/000527583
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Article ; Online: Hemodiafiltration in developing countries.

Kusirisin, Prit / Srisawat, Nattachai

Seminars in dialysis

2022 Volume 35, Issue 5, Page(s) 449–456

Abstract: Hemodiafiltration (HDF) is a promising kidney replacement therapy modality for patients with end-stage kidney disease. The principle of uremic toxin clearance by combining convection and diffusion can lead to greater benefits compared to conventional ... ...

Abstract	Hemodiafiltration (HDF) is a promising kidney replacement therapy modality for patients with end-stage kidney disease. The principle of uremic toxin clearance by combining convection and diffusion can lead to greater benefits compared to conventional hemodialysis. Evidence is building that supports the advantages of HDF with short-term outcomes such as greater intradialytic hemodynamic stability, improved nutritional status, attenuation of anemia, and reduction of inflammatory cytokines which produce improved key long-term impacts including survival and cardiovascular outcomes. Very little is known about the prevalence of HDF treatments in developing countries due to a shortage of national kidney registries. HDF experience is limited in many countries due to the cost of dialysis treatments, availability of online HDF machines, and reimbursement policies. These obstacles have led to nephrologists developing innovations, for example, convective control HDF (CC-HDF), simple mid-dilution, and simple mixed-dilution methods, which may be as effective as commercially available HDF machines. In this article, we will focus on the experience of HDF practice and barriers to adoption in developing countries. Results can guide clinical practice recommendations for implementing HDF in resource-limited settings.
MeSH term(s)	Cytokines ; Developing Countries ; Hemodiafiltration/methods ; Humans ; Kidney Failure, Chronic/therapy ; Renal Dialysis ; Uremic Toxins
Chemical Substances	Cytokines ; Uremic Toxins
Language	English
Publishing date	2022-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.13077
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Article ; Online: The Efficacy of Early Additional Hemoperfusion Therapy for Severe COVID-19 Patients: A Prospective Cohort Study.

Surasit, Karjbundid / Srisawat, Nattachai

Blood purification

2022 Volume 51, Issue 11, Page(s) 879–888

Abstract: Introduction: Currently, the effect of hemoperfusion on outcome in severe COVID-19 patients is still unknown. Therefore, we aimed to investigate the effects of early HA-330 hemoperfusion in severe COVID-19 patients.: Methods: We conducted a single ... ...

Abstract	Introduction: Currently, the effect of hemoperfusion on outcome in severe COVID-19 patients is still unknown. Therefore, we aimed to investigate the effects of early HA-330 hemoperfusion in severe COVID-19 patients. Methods: We conducted a single center, prospective cohort study on patients who were diagnosed with severe COVID-19 patients and admitted to ICU. Patients in hemoperfusion group (defined as patients who were treated with hemoperfusion therapy at least 3 sessions in combination with standard therapy) were compared with the control group (defined as patients who received standard treatment alone or received less than 3 sessions of hemoperfusion therapy). The primary outcome was daily sequential organ failure assessment (SOFA) scores. Secondary outcomes were all-cause mortality at 28 days, mechanical ventilator-free day, daily C-reactive protein (CRP), oxygenation (defined by PaO2/FiO2 ratio), and severity score of lung infiltration on the chest X-ray (CXR RALE score). All outcomes were adjusted by regression analysis to reduce the confounders due to some difference in baseline characteristics. Results: A total number of 29 severe and critical COVID-19 confirmed patients were enrolled. Fifteen patients were defined as hemoperfusion group and 14 were control group. The median of CRP and SOFA score at the baseline (the day after severe pneumonia diagnosis or before hemoperfusion) in hemoperfusion and control groups were comparable, 96.79 mg/L and 87.3 mg/L, p = 0.53, 3.53 ± 0.99 versus 4.3 ± 1.89, p = 0.15, respectively. Clinical improvement associated with decreased SOFA score and improvement of CXR RALE score were found in hemoperfusion group compared to control group (p = 0.008 and p = 0.005, respectively). The 28-day mortality rate was significantly lower in hemoperfusion group compared to control group (6.67% vs. 85.71%, p < 0.001) and the adjusted hazard ratio of death was 0.017 (95% confidence interval = 0.008-0.351, p = 0.008). Conclusions: The addition of early HA-330 hemoperfusion to standard therapy improved severity of organ failure and might reduce the mortality rate. However, the results were affected by the baseline confounders and limited sample size.
MeSH term(s)	Humans ; Hemoperfusion/methods ; COVID-19/therapy ; Prospective Studies ; Respiratory Sounds ; Organ Dysfunction Scores
Language	English
Publishing date	2022-02-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000521713
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Article ; Online: Immunomodulation Effect of Regional Citrate Anticoagulation in Acute Kidney Injury Requiring Renal Replacement Therapy.

Kaewdoungtien, Piyanut / Tachaboon, Sasipha / Kangsumrith, Natamon / Srisawat, Nattachai

Blood purification

2023 Volume 52, Issue 5, Page(s) 474–482

Abstract: Introduction: Acute kidney injury (AKI) is a common syndrome in critically ill patients. Continuous renal replacement therapy (CRRT) is the standard treatment for patients with AKI. Research on the immunomodulating effects of regional citrate ... ...

Abstract	Introduction: Acute kidney injury (AKI) is a common syndrome in critically ill patients. Continuous renal replacement therapy (CRRT) is the standard treatment for patients with AKI. Research on the immunomodulating effects of regional citrate anticoagulation (RCA) remains limited in patients with AKI receiving CRRT. We aimed to evaluate the immunomodulating effects of RCA in patients with AKI receiving CRRT. Methods: A randomized controlled trial study on critically ill adult patients with AKI undergoing CRRT was undertaken. Participants were randomized into either a regional citrate group or control group (either heparin anticoagulant or normal saline). Measurements were taken at baseline, 6 and 24 h after commencing CRRT for CD11b expression, C3a, C5a, and plasminogen activator inhibitor-1 (PAI-1) levels. Clinical outcomes assessed were 28-day survival rate, length of ICU stay, renal support duration, and renal function at discharge. Results: Thirty patients were recruited and randomized into 2 groups of 15 subjects. Baseline demographic and clinical data were comparable between groups. In the citrate group, CD11b expression was significantly decreased at 24 h compared to the control group (1.84% [1.18-3.32] versus 4.92% [2.63-6.93], p < 0.01). The complement level, including c3b and c5a, was stable during CRRT. Additionally, the PAI-1 levels were significantly decreased at 24 h compared to the control group (114 ng/mL [19-193] versus 359 ng/mL [264-491], p < 0.01). No significant difference in survival rate was observed. Conclusions: RCA may have the potential to mitigate the inflammatory response by decreasing CD11b expression of neutrophil and improve fibrinolysis activity through a reduction of PAI-1 levels. Larger clinical trials are warranted to test this immunomodulation effect of RCA.
MeSH term(s)	Adult ; Humans ; Citric Acid/therapeutic use ; Continuous Renal Replacement Therapy ; Plasminogen Activator Inhibitor 1/therapeutic use ; Critical Illness ; Anticoagulants/therapeutic use ; Renal Replacement Therapy ; Citrates/therapeutic use ; Acute Kidney Injury
Chemical Substances	Citric Acid (2968PHW8QP) ; Plasminogen Activator Inhibitor 1 ; Anticoagulants ; Citrates
Language	English
Publishing date	2023-03-14
Publishing country	Switzerland
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000529350
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Article ; Online: CRRT in developing world.

Srisawat, Nattachai / Chakravarthi, Rajasekara

Seminars in dialysis

2021 Volume 34, Issue 6, Page(s) 567–575

Abstract: Continuous renal replacement therapy (CRRT) has become a mainstay therapy in the intensive care unit (ICU) and its utilization continues to increase in developed countries. The wide variations of CRRT practice, however, are evident in developing ... ...

Abstract	Continuous renal replacement therapy (CRRT) has become a mainstay therapy in the intensive care unit (ICU) and its utilization continues to increase in developed countries. The wide variations of CRRT practice, however, are evident in developing countries while clinicians in these resource-limited countries encounter various barriers such as a limited number of nephrologists and trained staff, a gap of knowledge, machine unavailability, cultural and socioeconomic aspects, high-cost therapy without reimbursement, and administrative as well as governmental barriers. In this article, we demonstrate the situation of CRRT and discuss the barriers of CRRT in a resource-limited setting. We also discuss the strategies to improve CRRT practice. These recommendations can serve as a fundamental guideline for clinicians to implement CRRT in low-resource settings.
MeSH term(s)	Acute Kidney Injury/therapy ; Continuous Renal Replacement Therapy ; Humans ; Intensive Care Units ; Renal Dialysis ; Renal Replacement Therapy
Language	English
Publishing date	2021-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	1028193-9
ISSN	1525-139X ; 0894-0959
ISSN (online)	1525-139X
ISSN	0894-0959
DOI	10.1111/sdi.12975
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Article: A Case of Extranodal NK/T-cell Lymphoma Infiltrating Kidneys, Presenting With Hematuria and Proteinuria With False-Positive Serum Anti-proteinase 3, and Mimicking Granulomatosis With Polyangiitis.

Puapatanakul, Pongpratch / Banjongjit, Athiphat / Srisawat, Nattachai / Townamchai, Natavudh / Kanjanabuch, Talerngsak

Cureus

2023 Volume 15, Issue 12, Page(s) e49794

Abstract: We report a case of misdiagnosed extranodal NK/T-cell lymphoma, nasal type, mimicking granulomatosis with polyangiitis (GPA). A 30-year-old male presented with chronic non-resolving right paranasal sinusitis for two years accompanied by multiple ... ...

Abstract	We report a case of misdiagnosed extranodal NK/T-cell lymphoma, nasal type, mimicking granulomatosis with polyangiitis (GPA). A 30-year-old male presented with chronic non-resolving right paranasal sinusitis for two years accompanied by multiple generalized cutaneous nodules, and subnephrotic-range proteinuria. Biopsies from skin lesions and paranasal sinuses demonstrated leukocytoclastic vasculitis and necrotizing granulomatous inflammation, respectively. Serum proteinase 3 (PR3)-antineutrophilic cytoplasmic antibody (ANCA) was positive, suggesting the diagnosis of GPA based on the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for GPA. A kidney biopsy was not pursued due to the cause of glomerulonephritis (GN) being clinically evident, per the KDIGO 2021 GN Clinical Practice Guidelines. Immunosuppression was administered, which led to a transient improvement in clinical symptoms. However, subsequent kidney biopsy and other organ biopsies with cytogenic and molecular tests eventually confirmed extranodal NK/T-cell lymphoma infiltrating kidneys, skin, and paranasal sinuses. Physicians should always consider the possibility of hematologic malignancy in young adults presenting with multiple-organ involvement with vasculitic lesions or pauci-immune crescentic GN, albeit positive ANCA serologies. Kidney biopsy with cytogenic support should be performed to exclude threatening diseases, especially in atypical cases such as in young patients despite a context of compatible manifestations with other syndromes.
Language	English
Publishing date	2023-12-01
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.49794
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Article ; Online: Effectiveness of Multidisciplinary Post-Acute Kidney Injury Clinic on Awareness and Knowledge in Acute Kidney Injury Survivors.

Thanapongsatorn, Peerapat / Krisem, Massupa / Kaewnan, Kanyarat / Bumrungpet, Tidarat / Srisawat, Nattachai

Blood purification

2023 Volume 53, Issue 4, Page(s) 268–278

Abstract: Introduction: Acute kidney injury (AKI) awareness and knowledge among survivors is poor, leading to suboptimal self-management and follow-up care. The purpose of the study was to evaluate the impact of a multidisciplinary post-AKI clinic on AKI ... ...

Abstract	Introduction: Acute kidney injury (AKI) awareness and knowledge among survivors is poor, leading to suboptimal self-management and follow-up care. The purpose of the study was to evaluate the impact of a multidisciplinary post-AKI clinic on AKI awareness and knowledge among survivors. Methods: We conducted a quasi-experimental study among stage 2-3 AKI survivors who were followed in the multidisciplinary post-AKI clinic, comprising nephrologists, renal nurses, pharmacists, and dietitians. Patients were evaluated before and after entering the clinic during a 3-month follow-up period, using a three-component questionnaire including the following: (1) Do you know of your AKI diagnosis during hospitalization? (yes/no), (2) how do you rate your AKI knowledge? (ranging from 1 or "very low" to 5 or "excellent"), and (3) 25-item objective AKI knowledge survey instrument that covered general knowledge of AKI, nutrition, medication, and symptoms of renal failure. Results: A total of 108 AKI survivors were enrolled, with 37.0%, 41.7%, and 21.3% being stage 2 AKI, stage 3 AKI, and stage 3-dialysis AKI, respectively. Before entering the clinic, 50% of patients were unaware of their AKI during hospitalization. After receiving education from the multidisciplinary post-AKI clinic, all patients became aware they had experienced AKI. The mean perceived knowledge and objective knowledge scores were significantly increased over the 3-month period from 1.6 (0.7) to 3.9 (0.7) out of 5 and 15.4 (3.5) to 21.4 (2.0) out of 25, respectively (p < 0.001 for both). Additionally, reverse transformation of the Likert scale to a percentage format also revealed a significant improvement in mean perceived AKI knowledge scores, transitioning from 13.8 ± 16.8 to 73.0 ± 17.6, p < 0.001. Conclusion: The multidisciplinary post-AKI clinic effectively enhanced AKI awareness and knowledge among survivors. These findings highlight the importance of follow-up care and the benefits of a multidisciplinary approach. Further studies are needed to determine the long-term outcomes associated with increased knowledge.
MeSH term(s)	Humans ; Renal Dialysis ; Acute Kidney Injury/therapy ; Acute Kidney Injury/diagnosis ; Survivors ; Surveys and Questionnaires ; Nephrologists
Language	English
Publishing date	2023-11-21
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	605548-5
ISSN	1421-9735 ; 0253-5068
ISSN (online)	1421-9735
ISSN	0253-5068
DOI	10.1159/000535246
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Article: COVID-19: Lessons from Thailand.

Srisawat, Nattachai / Iamsirithaworn, Sopon / Tantawichiein, Terapong / Thisyakorn, Usa

Annals of the Academy of Medicine, Singapore

2021 Volume 50, Issue 1, Page(s) 96–98

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19/transmission ; Communicable Disease Control/organization & administration ; Humans ; Thailand/epidemiology
Language	English
Publishing date	2021-02-24
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
DOI	10.47102/annals-acadmedsg.2020408
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Article ; Online: The haemodynamic effects of oXiris haemofilter in septic shock patients requiring renal support: A single-centre experience.

Lumlertgul, Nuttha / Srisawat, Nattachai

The International journal of artificial organs

2020 Volume 44, Issue 1, Page(s) 17–24

Abstract: Excessive pro-inflammatory and anti-inflammatory cytokines are mediators for haemodynamic alterations, metabolic acidosis, and multi-organ failure in sepsis. Recently, ... ...

Abstract	Excessive pro-inflammatory and anti-inflammatory cytokines are mediators for haemodynamic alterations, metabolic acidosis, and multi-organ failure in sepsis. Recently, oXiris
MeSH term(s)	Acute Kidney Injury/therapy ; Adult ; Female ; Hemodynamics/physiology ; Hemofiltration/instrumentation ; Hemofiltration/methods ; Humans ; Intensive Care Units ; Male ; Membranes, Artificial ; Middle Aged ; Multiple Organ Failure/therapy ; Organ Dysfunction Scores ; Renal Replacement Therapy/instrumentation ; Renal Replacement Therapy/methods ; Retrospective Studies ; Shock, Septic/therapy
Chemical Substances	Membranes, Artificial
Language	English
Publishing date	2020-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80456-3
ISSN	1724-6040 ; 0391-3988
ISSN (online)	1724-6040
ISSN	0391-3988
DOI	10.1177/0391398820917150
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Article ; Online: The effect of citrate in cardiovascular system and clot circuit in critically ill patients requiring continuous renal replacement therapy.

Trakarnvanich, Thananda / Sirivongrangson, Phatadon / Trongtrakul, Konlawij / Srisawat, Nattachai

Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs

2022 Volume 26, Issue 1, Page(s) 53–64

Abstract: We aimed to evaluate the impact of citrate on hemodynamic responses and secondary outcomes, including the filter life span, metabolic complications, and levels of inflammatory cytokines, in critically ill patients who required CRRT compared with those ... ...

Abstract	We aimed to evaluate the impact of citrate on hemodynamic responses and secondary outcomes, including the filter life span, metabolic complications, and levels of inflammatory cytokines, in critically ill patients who required CRRT compared with those who underwent the heparin-free method. This prospective, multicenter, open-label randomized trial compared regional citrate anticoagulation (RCA) with a heparin-free protocol in severe acute kidney injury (AKI) patients who received continuous venovenous hemodiafiltration (CVVHDF) in the postdilution mode. We measured hemodynamic changes using the FloTrac Sensor/EV1000™ Clinical Platform at certain time points after starting CRRT (0, 6, 12, 24, 48, and 72 h.). The levels of inflammatory cytokines (IL-1β, IL-6, IL-8, IL-10 and TNF-ɑ) were measured on days 1 and 3. Forty-one patients were recruited and randomized into the heparin (n = 20) and citrate groups (n = 21). The cardiac performances were not significantly different between the 2 groups at any time point. The inflammatory cytokines declined similarly in both treatment arms. The maximum filter survival time was insignificantly longer in the RCA group than in the heparin-free group (44.64 ± 26.56 h. vs p = 0.693 in citrate and heparin free group). No serious side effects were observed for either treatment arm, even in the group of liver dysfunction patients. RCA did not affect hemodynamic changes during CRRT. Inflammatory cytokines decreased similarly in both treatment arms.The filter life span was longer in the citrate group. RCA is a valid alternative to traditional anticoagulation and results in stable hemodynamic parameters.
MeSH term(s)	Humans ; Citric Acid ; Continuous Renal Replacement Therapy/adverse effects ; Anticoagulants/therapeutic use ; Critical Illness ; Prospective Studies ; Heparin/therapeutic use ; Citrates/therapeutic use ; Thrombosis/complications ; Cardiovascular System ; Cytokines ; Renal Replacement Therapy/methods ; Acute Kidney Injury/therapy
Chemical Substances	Citric Acid (2968PHW8QP) ; Anticoagulants ; Heparin (9005-49-6) ; Citrates ; Cytokines
Language	English
Publishing date	2022-04-12
Publishing country	Japan
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	1463555-0
ISSN	1619-0904 ; 1434-7229
ISSN (online)	1619-0904
ISSN	1434-7229
DOI	10.1007/s10047-022-01329-0
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