The Role of Hemodialysis in Toxicology including neonates: A Systematic Review
DOI:
https://doi.org/10.52783/jns.v14.1697Keywords:
Toxicology, Nephrology, Hemodialysis, poisonsAbstract
Background: The management of poisoned patients often is complicated by the need for renal replacement therapies, particularly hemodialysis, to effectively address acute poisonings complicated by renal dysfunction.
Objective: This systematic review synthesizes current literature concerning the use of hemodialysis in toxicology, assessing its effectiveness at toxin clearance and its association with complications.
Methods: A literature search was conducted across major databases, including PubMed, Embase, Cochrane Library, and Web of Science, focusing on articles published from January 2000 to October 2023 that analyze hemodialysis for toxic substance removal. Data extraction prioritized toxin types, patient demographics, hemodialysis specifics, and clinical outcomes.
Results: Hemodialysis is most effective for water-soluble and minimally protein-bound toxins like acetaminophen, lithium, salicylates, methanol, and ethylene glycol. Its effectiveness decreases with highly protein-bound substances, those with a high volume of distribution, and volatile compounds. Inborn errors of metabolism can cause toxic metabolite buildup, affecting neonatal brain development. A study of 20 cases showed that timely hemodialysis improved clinical outcomes in 85% of patients. Common complications include hypotension, infections, and electrolyte imbalances, which require close monitoring and tailored interventions.
Conclusion: Hemodialysis is an important tool in the management of toxicological emergencies. However, the success of hemodialysis is dependent on many factors, including the characteristics of the toxin and the patient's health status. Recent advances in dialysis membranes and Continuous Renal Replacement Therapy have improved its use in such cases. However, there are limitations to its use, and alternative treatment strategies must be considered for some poisonings. This review discusses kidney replacement therapy options, challenges for infants, and the importance of informed catheter use by interventional radiologists.
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Mirrakhimov AE, Barbaryan A, Gray A, Ayach T. The Role of Renal Replacement Therapy in the Management of Pharmacologic Poisonings. Int J Nephrol. 2016;2016:3047329. doi: 10.1155/2016/3047329.
Yu, C.-H.; Huang, L.-C.; Su, Y.-J. Poisoning-Induced Acute Kidney Injury: A Review. Medicina 2024, 60, 1302. https://doi.org/10.3390/medicina60081302
Vodovar, D.; Peyre, H.; Mégarbane, B. Relationship between acute kidney injury and mortality in poisoning–a systematic review and metanalysis. Clin. Toxicol. 2021, 59, 771–779.
van Gelder MK, Middel IR, Vernooij RWM, Bots ML, Verhaar MC, Masereeuw R, Grooteman MP, Nubé MJ, van den Dorpel MA, Blankestijn PJ, Rookmaaker MB, Gerritsen KGF. Protein-Bound Uremic Toxins in Hemodialysis Patients Relate to Residual Kidney Function, Are Not Influenced by Convective Transport, and Do Not Relate to Outcome. Toxins (Basel). 2020 Apr 7;12(4):234. doi: 10.3390/toxins12040234.
Masereeuw R., Mutsaers H.A., Toyohara T., Abe T., Jhawar S., Sweet D.H., Lowenstein J. The kidney and uremic toxin removal: Glomerulus or tubule? Semin. Nephrol. 2014;34:191–208. doi: 10.1016/j.semnephrol.2014.02.010.
Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, Wainstein M, Johnson DW. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022 Jun;18(6):378-395. doi: 10.1038/s41581-022-00542-7.
Chander S, Luhana S, Sadarat F, Parkash O, Rahaman Z, Wang HY, Kiran F, Lohana AC, Sapna F, Kumari R. Mortality and mode of dialysis: meta-analysis and systematic review. BMC Nephrol. 2024 Jan 3;25(1):1. doi: 10.1186/s12882-023-03435-4.
Dart RC, Mullins ME, Matoushek T, et al. Management of Acetaminophen Poisoning in the US and Canada: A Consensus Statement. JAMA Netw Open. 2023;6(8):e2327739. doi:10.1001/jamanetworkopen.2023.27739
Cohen, Phillip; Kudchadkar, Sapna; Schultz, Brian; Schuette, Jennifer.: Repeated Hemodialysis After Extended-Release Acetaminophen Ingestion. Critical Care Medicine 52(1):p S301, January 2024. | DOI: 10.1097/01.ccm.0001000800.79837.b6
Marbury TC, Wang LH, Lee CS. Hemodialysis of Acetaminophen in Uremic Patients. The International Journal of Artificial Organs. 1980;3(5):263-266. doi:10.1177/039139888000300506.
Chiu, Michael H., Jaworska, Natalia, Li, Nicholas L., Yarema, Mark, Massive Acetaminophen Overdose Treated Successfully with N-Acetylcysteine, Fomepizole, and Hemodialysis, Case Reports in Critical Care, 2021, 6695967, 5 pages, 2021. https://doi.org/10.1155/2021/6695967.
Kulkarni A, Shrivastava P, Phulara RK. Timely Hemodialysis for Successful Treatment of Acute Salicylate Overdose in a Young Adult Female - A Case Report. Indian J Nephrol. 2024 Jan-Feb;34(1):67-69. doi: 10.4103/ijn.ijn_141_22.
Lavonas EJ, Buchanan J. Hemodialysis for lithium poisoning. Cochrane Database Syst Rev. 2015 Sep 16;2015(9):CD007951. doi: 10.1002/14651858.CD007951.
Kulkarni A, Shrivastava P, Phulara RK. Timely Hemodialysis for Successful Treatment of Acute Salicylate Overdose in a Young Adult Female - A Case Report. Indian J Nephrol. 2024 Jan-Feb;34(1):67-69. doi: 10.4103/ijn.ijn_141_22.
Illescas, A.C., Argyropoulos, C.P., Combs, S.A. et al. Severe methanol poisoning treated with a novel hemodialysis system: a case report, analysis, and review. Ren Replace Ther 7, 43 (2021). https://doi.org/10.1186/s41100-021-00362-8.
Canaud B, Stuard S, Laukhuf F, Yan G, Canabal MIG, Lim PS, Kraus MA. Choices in hemodialysis therapies: variants, personalized therapy and application of evidence-based medicine. Clin Kidney J. 2021 Dec 27;14(Suppl 4):i45-i58. doi: 10.1093/ckj/sfab198.
Sahathevan S, Khor BH, Ng HM, Gafor AHA, Mat Daud ZA, Mafra D, Karupaiah T. Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review. Nutrients. 2020 Oct 15;12(10):3147. doi: 10.3390/nu12103147.
Habas EM, Habas A, Elgamal ME, Shraim BA, Moursi MO, Ibrahim AR, et al. Common complications of hemodialysis: A clinical review. Ibnosina J Med Biomed Sci 2021;13:16172.
Elmukhtar Habas , Aml Habas , Mohamed Elgamal , Bara Shraim , Moaz Moursi , Ayman Ibrahim , Mohamed Danjuma , Abdel-Naser Elzouki. Common complications of hemodialysis: A clinical review. Ibnosina Journal of Medicine and Biomedical Sciences 2021; 13(04): 161-172. DOI: 10.4103/ijmbs.ijmbs_62_21.
Canaud B. Recent advances in dialysis membranes. Curr Opin Nephrol Hypertens. 2021 Nov 1;30(6):613-622. doi: 10.1097/MNH.0000000000000744.
Tandukar S, Palevsky PM. Continuous Renal Replacement Therapy: Who, When, Why, and How. Chest. 2019 Mar;155(3):626-638. doi: 10.1016/j.chest.2018.09.004.
Scofano R, Monteiro A, Motta L. Evaluation of the experience with the use of telemedicine in a home dialysis program-a qualitative and quantitative study. BMC Nephrol. 2022 May 19;23(1):190. doi: 10.1186/s12882-022-02824-5.
Gozubatik-Celik G, Uluduz D, Goksan B, Akkaya N, Sohtaoglu M, Uygunoglu U, Kircelli F, Sezen A, Saip S, Karaali Savrun F, Siva A. Hemodialysis-related headache and how to prevent it. Eur J Neurol. 2019 Jan;26(1):100-105.
Karunaratne K, Taube D, Khalil N, Perry R, Malhotra PA. Neurological complications of renal dialysis and transplantation. Pract Neurol. 2018 Apr;18(2):115-125. [PubMed]
Masud A, Costanzo EJ, Zuckerman R, Asif A. The Complications of Vascular Access in Hemodialysis. Semin Thromb Hemost. 2018 Feb;44(1):57-59
Khatri VP, Pavlides CA. Method of salvaging long-term dialysis catheters. Am Surg. 1995 Nov;61(11):1013-5.
Mullins, Michael E. et al. The Role of the Nephrologist in Management of Poisoning and Intoxication: Core Curriculum 2022. American Journal of Kidney Diseases, Volume 79, Issue 6, 877 – 889.
Eisenstein I, Pollack S, Hadash A, Eytan D, Attias O, Halberthal M, Ben-Ari J, Bar-Joseph G, Zelikovic I, Mandel H, Tal G, Magen D. Acute hemodialysis therapy in neonates with inborn errors of metabolism. Pediatr Nephrol. 2022 Nov;37(11):2725-2732. doi: 10.1007/s00467-022-05507-3.
Das, Chandan J. et al. Hemodialysis in Infants: Challenges and New Paradigms, Journal of Vascular and Interventional Radiology, Volume 31, Issue 5, 787
Slagle, Cara et al.Recent Advances in Kidney Replacement Therapy in Infants: A Review. American Journal of Kidney Diseases, Volume 83, Issue 4, 519 - 530
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