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  1. Article ; Online: Management of Acute Kidney Injury/Renal Replacement Therapy in the Intensive Care Unit.

    Shaikhouni, Salma / Yessayan, Lenar

    The Surgical clinics of North America

    2021  Volume 102, Issue 1, Page(s) 181–198

    Abstract: Common causes of acute kidney injury (AKI) in the ICU setting include acute tubular necrosis (due to shock, hemolysis, rhabdomyolysis, or procedures that compromise renal perfusion), abdominal compartment syndrome, urinary retention, and interstitial ... ...

    Abstract Common causes of acute kidney injury (AKI) in the ICU setting include acute tubular necrosis (due to shock, hemolysis, rhabdomyolysis, or procedures that compromise renal perfusion), abdominal compartment syndrome, urinary retention, and interstitial nephritis. Treatment is geared toward addressing the underlying cause. Dialysis may be required if renal injury does not resolve. Early initiation of dialysis based on the stage of AKI alone has not been shown to provide a mortality benefit. Dialysis modalities are based on the dialysis indication and the patient's clinical status. Providers should pay close attention to nutritional requirements and medication dosing according to renal function and dialysis modality.
    MeSH term(s) Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Critical Care/methods ; Humans ; Intensive Care Units ; Postoperative Complications/etiology ; Postoperative Complications/therapy ; Renal Replacement Therapy/methods ; Risk Factors
    Language English
    Publishing date 2021-11-17
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 215713-5
    ISSN 1558-3171 ; 0039-6109
    ISSN (online) 1558-3171
    ISSN 0039-6109
    DOI 10.1016/j.suc.2021.09.013
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  2. Article ; Online: Innovations in CKRT: individualized therapy with fewer complications.

    Szamosfalvi, Balazs / Yessayan, Lenar

    Nature reviews. Nephrology

    2020  Volume 16, Issue 10, Page(s) 560–561

    MeSH term(s) Acute Kidney Injury/therapy ; Blood Coagulation Disorders/prevention & control ; Cloud Computing ; Continuous Renal Replacement Therapy/adverse effects ; Continuous Renal Replacement Therapy/instrumentation ; Continuous Renal Replacement Therapy/methods ; Extracorporeal Membrane Oxygenation/instrumentation ; Extracorporeal Membrane Oxygenation/methods ; Humans ; Inventions ; Monitoring, Physiologic/methods ; Precision Medicine/adverse effects ; Precision Medicine/instrumentation ; Precision Medicine/methods
    Keywords covid19
    Language English
    Publishing date 2020-07-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2490366-8
    ISSN 1759-507X ; 1759-5061
    ISSN (online) 1759-507X
    ISSN 1759-5061
    DOI 10.1038/s41581-020-0326-1
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  3. Article ; Online: Extracorporeal Immunomodulation Therapy in Acute Chronic Liver Failure With Multiorgan Failure: First in Human Use.

    Yessayan, Lenar T / Sharma, Pratima / Westover, Angela J / Szamosfalvi, Balazs / Humes, H David

    ASAIO journal (American Society for Artificial Internal Organs : 1992)

    2023  Volume 70, Issue 3, Page(s) e53–e56

    Abstract: Two patients presented with acute on chronic liver failure and multiorgan failure and, as typical for this disorder, they presented with hyperinflammation and anticipated high mortality rates. Both cases were diagnosed with hepatorenal syndrome (HRS). ... ...

    Abstract Two patients presented with acute on chronic liver failure and multiorgan failure and, as typical for this disorder, they presented with hyperinflammation and anticipated high mortality rates. Both cases were diagnosed with hepatorenal syndrome (HRS). Under a FDA approved Investigational Device Exemption clinical trial, they underwent treatment with an extracorporeal cell-directed immunomodulatory device, called selective cytopheretic device. Both patients showed rapid clinical improvement associated with a decline in elevated blood cytokine concentrations and diminution of activation levels of circulating leukocytes. On follow-up, one patient was alive at day 90 after treatment and undergoing liver transplantation evaluation and the other patient had a successful liver transplantation 6 days after selective cytopheretic device therapy ended. These cases represent the first in human evaluation of extracorporeal cell-directed immunomodulation therapy in acute on chronic liver failure with successful clinical outcomes in a disorder with dismal prognosis.
    MeSH term(s) Humans ; Acute-On-Chronic Liver Failure/therapy ; End Stage Liver Disease/complications ; End Stage Liver Disease/therapy ; Immunomodulation ; Multiple Organ Failure/etiology ; Multiple Organ Failure/therapy ; Prognosis
    Language English
    Publishing date 2023-08-29
    Publishing country United States
    Document type Clinical Trial ; Journal Article
    ZDB-ID 759982-1
    ISSN 1538-943X ; 0162-1432 ; 1058-2916
    ISSN (online) 1538-943X
    ISSN 0162-1432 ; 1058-2916
    DOI 10.1097/MAT.0000000000002033
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  4. Article ; Online: Selective Cytopheretic Device Use in Continuous Kidney Replacement Therapy in Children: A Cohort Study With a Historical Comparator.

    Goldstein, Stuart L / Ollberding, Nicholas J / Askenazi, David J / Basu, Rajit K / Selewski, David T / Krallman, Kelli A / Yessayan, Lenar / Humes, Harvey David

    Kidney medicine

    2024  Volume 6, Issue 4, Page(s) 100792

    Abstract: Rationale and objective: Critically ill children with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) are at increased risk of death. The selective cytopheretic device (SCD) promotes an immunomodulatory effect at circuit- ... ...

    Abstract Rationale and objective: Critically ill children with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) are at increased risk of death. The selective cytopheretic device (SCD) promotes an immunomodulatory effect at circuit-ionized calcium of <0.40 mmol/L. In an adult CRRT patient study, SCD-treated patients reported improved survival or dialysis independence. We reported safety data from children who received CRRT-SCD therapy and compared outcomes with a historic pediatric CRRT cohort.
    Study design: We performed 2 prospective multicenter studies to evaluate the safety and feasibility of SCD in critically ill children.
    Setting and participants: Four pediatric institutions enrolled children weighing 10 kg or more with AKI and multi-organ dysfunction receiving CRRT as the standard of care with the SCD-integrated post-CRRT membrane.
    Exposure: Patients received CRRT-SCD with regional citrate anticoagulation for up to 7-10 days, or CRRT discontinuation, whichever came first.
    Analytical approach: We reported serious adverse events among patients and CRRT-SCD-related process and outcome variables. We compared survival to intensive care unit (ICU) discharge rates between the CRRT-SCD cohort and a matched cohort from the prospective pediatric CRRT registry, using odds ratios in multivariable analysis for factors associated with prospective pediatric CRRT patient ICU mortality. To validate these crude analyses, Bayesian logistic regression was performed to assess for attributable benefit-risk assessment of the SCD.
    Results: Twenty-two patients received CRRT-SCD treatments. Fifteen serious adverse events were recorded; none were SCD-related. Seventeen patients survived till ICU discharge or day 60. Both multivariable and Bayesian analyses revealed a probable benefit of the addition of SCD. Fourteen of the 16 patients surviving ICU discharge reported a normal estimated glomerular filtration rate and no patient was dialysis dependent at 60 days.
    Limitations: The study had a few limitations, such as (1) a small sample size in the SCD-PED cohort group; (2) unchanging historic control group; and (3) adverse events were not recorded in the control group.
    Conclusions: The SCD therapy is feasible, safe, and demonstrates probable benefit for critically ill children who require CRRT for AKI.
    Language English
    Publishing date 2024-02-15
    Publishing country United States
    Document type Journal Article
    ISSN 2590-0595
    ISSN (online) 2590-0595
    DOI 10.1016/j.xkme.2024.100792
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  5. Article ; Online: Rationale and Design of NEUTRALIZE-AKI: A Multicenter, Randomized, Controlled, Pivotal Study to Assess the Safety and Efficacy of a Selective Cytopheretic Device in Patients with Acute Kidney Injury Requiring Continuous Kidney Replacement Therapy.

    Yessayan, Lenar / Humes, H David / Scribe, Emily C / Iyer, Sai Prasad N / Chung, Kevin K

    Nephron

    2023  Volume 148, Issue 1, Page(s) 43–53

    Abstract: Introduction: NEUTRALIZE-AKI is a pivotal study to evaluate the safety and effectiveness of the selective cytopheretic device (SCD) in adult patients with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT).: Methods/ ... ...

    Abstract Introduction: NEUTRALIZE-AKI is a pivotal study to evaluate the safety and effectiveness of the selective cytopheretic device (SCD) in adult patients with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT).
    Methods/design: This is a two-arm, randomized, open-label, controlled multi-center pivotal US study which will enroll 200 adult patients (age 18-80 years) in the intensive care unit with acute kidney injury requiring CKRT and at least one additional organ failure across 30 clinical centers. Eligible patients will be randomized to CKRT plus SCD therapy versus CKRT alone. Therapy will be administered for up to 10 days, with the hypothesis that the CKRT plus SCD group will demonstrate a lower mortality rate or better rate of renal recovery than the CKRT alone group by day 90. The primary outcome is a composite of dialysis dependence or all-cause mortality at day 90.
    Conclusion: The SCD is a cell-directed extracorporeal therapy that targets and deactivates pro-inflammatory neutrophils and monocytes, with evidence of efficacy across a variety of critically ill patient populations. Knowledge and experience from many of those studies and other AKI trials were incorporated into the design of this pivotal study, with the aim to investigate the role of effector cell immunomodulation in the intervention of AKI.
    MeSH term(s) Adult ; Humans ; Adolescent ; Young Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Renal Dialysis/adverse effects ; Treatment Outcome ; Intensive Care Units ; Critical Care ; Acute Kidney Injury/etiology ; Critical Illness/therapy ; Renal Replacement Therapy
    Language English
    Publishing date 2023-07-13
    Publishing country Switzerland
    Document type Randomized Controlled Trial ; Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 207121-6
    ISSN 2235-3186 ; 1423-0186 ; 1660-8151 ; 0028-2766
    ISSN (online) 2235-3186 ; 1423-0186
    ISSN 1660-8151 ; 0028-2766
    DOI 10.1159/000531880
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  6. Article ; Online: Citrate Anticoagulation for Continuous Kidney Replacement Therapy: An Embarrassment of RICH-es.

    Szamosfalvi, Balazs / Yessayan, Lenar T / Heung, Michael

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2021  Volume 78, Issue 1, Page(s) 146–150

    MeSH term(s) Anticoagulants/therapeutic use ; Citric Acid/therapeutic use ; Continuous Renal Replacement Therapy ; Humans ; Randomized Controlled Trials as Topic
    Chemical Substances Anticoagulants ; Citric Acid (2968PHW8QP)
    Language English
    Publishing date 2021-01-22
    Publishing country United States
    Document type Editorial
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2021.01.005
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  7. Article ; Online: Technology Innovations in Continuous Kidney Replacement Therapy: The Clinician's Perspective.

    Szamosfalvi, Balazs / Heung, Michael / Yessayan, Lenar

    Advances in chronic kidney disease

    2021  Volume 28, Issue 1, Page(s) 3–12

    Abstract: Continuous kidney replacement therapy (CKRT) has improved remarkably since its first implementation as continuous arteriovenous hemofiltration in the 1970s. However, when looking at the latest generation of CKRT machines, one could argue that clinical ... ...

    Abstract Continuous kidney replacement therapy (CKRT) has improved remarkably since its first implementation as continuous arteriovenous hemofiltration in the 1970s. However, when looking at the latest generation of CKRT machines, one could argue that clinical deployment of breakthrough innovations by device manufacturers has slowed in the last decade. Simultaneously, there has been a steady accumulation of clinical knowledge using CKRT as well as a multitude of therapeutic and diagnostic innovations in the dialysis and broader intensive care unit technology fields adaptable to CKRT. These include multiple different anticlotting measures; cloud-computing for optimized treatment prescribing and delivered therapy data collection and analysis; novel blood purification techniques aimed at improving the severe multiorgan dysfunction syndrome; and real-time sensing of blood and/or filter effluent composition. The authors present a view of how CKRT devices and programs could be reimagined incorporating these innovations to achieve specific measurable clinical outcomes with personalized care and improved simplicity, safety, and efficacy of CKRT therapy.
    MeSH term(s) Acute Kidney Injury ; Anticoagulants ; Continuous Renal Replacement Therapy ; Humans ; Intensive Care Units ; Renal Dialysis ; Technology
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2021-07-06
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 1548-5609 ; 1548-5595
    ISSN (online) 1548-5609
    ISSN 1548-5595
    DOI 10.1053/j.ackd.2021.03.021
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  8. Article ; Online: Management of dysnatremias with continuous renal replacement therapy.

    Yessayan, Lenar T / Szamosfalvi, Balazs / Rosner, Mitchell H

    Seminars in dialysis

    2021  Volume 34, Issue 6, Page(s) 472–479

    Abstract: Disorders of serum sodium concentration are common in critically ill patients who may have concomitant acute kidney injury, chronic kidney disease, or end-stage kidney disease. Many of these patients may require customized serum sodium level management ... ...

    Abstract Disorders of serum sodium concentration are common in critically ill patients who may have concomitant acute kidney injury, chronic kidney disease, or end-stage kidney disease. Many of these patients may require customized serum sodium level management with dialysis which, if not strictly controlled, can lead to significant complications. Thus, controlled correction of the serum sodium level is necessary to avoid the development of osmotic demyelination syndrome in hyponatremic patients and dialysis disequilibrium syndrome in hypernatremic patients. Continuous renal replacement therapy offers unique benefits through the ability to slowly and safely correct dysnatremias that can be tailored to specific patient needs and should be considered in select patients.
    MeSH term(s) Continuous Renal Replacement Therapy ; Humans ; Hypernatremia/complications ; Hypernatremia/therapy ; Hyponatremia/complications ; Hyponatremia/therapy ; Renal Dialysis/adverse effects ; Renal Replacement Therapy/adverse effects ; Sodium
    Chemical Substances Sodium (9NEZ333N27)
    Language English
    Publishing date 2021-07-03
    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.12983
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  9. Article ; Online: Recognizing Downstream Consequences of Acute Kidney Injury.

    Yessayan, Lenar / Heung, Michael

    American journal of nephrology

    2018  Volume 47, Issue 6, Page(s) 424–426

    MeSH term(s) Acute Kidney Injury ; Humans ; Renal Dialysis
    Language English
    Publishing date 2018-06-07
    Publishing country Switzerland
    Document type Editorial ; Comment
    ZDB-ID 604540-6
    ISSN 1421-9670 ; 0250-8095
    ISSN (online) 1421-9670
    ISSN 0250-8095
    DOI 10.1159/000489950
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  10. Article ; Online: Towards Consensus in Timing of Kidney Replacement Therapy for Acute Kidney Injury?

    Sohaney, Ryann / Yessayan, Lenar T / Heung, Michael

    American journal of kidney diseases : the official journal of the National Kidney Foundation

    2020  Volume 77, Issue 4, Page(s) 542–545

    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/therapy ; Consensus ; Humans ; Renal Replacement Therapy
    Language English
    Publishing date 2020-09-10
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 604539-x
    ISSN 1523-6838 ; 0272-6386
    ISSN (online) 1523-6838
    ISSN 0272-6386
    DOI 10.1053/j.ajkd.2020.08.004
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