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Neil Boyce - One of the best experts on this subject based on the ideXlab platform.

  • severe acute renal failure a comparison of acute Continuous Hemodiafiltration and conventional dialytic therapy
    Nephron, 1995
    Co-Authors: Rinaldo Bellomo, Geoffrey Parkin, Michael Farmer, Christopher Wright, Neil Boyce
    Abstract:

    It is unknown whether Continuous renal replacement techniques result in diminished morbidity and mortality when compared to conventional dialytic techniques. To investigate this issue a previously des

  • treatment of sepsis associated severe acute renal failure with Continuous Hemodiafiltration clinical experience and comparison with conventional dialysis
    Blood Purification, 1995
    Co-Authors: Rinaldo Bellomo, Geoffrey Parkin, Michael Farmer, Christopher Wright, Neil Boyce
    Abstract:

    The syndrome of sepsis-associated severe acute renal failure is a frequent component of sepsis-induced multiorgan failure. Continuous hemofiltration techniques are often used in its dialytic managemen

  • acute Continuous Hemodiafiltration a prospective study of 110 patients and a review of the literature
    American Journal of Kidney Diseases, 1993
    Co-Authors: Rinaldo Bellomo, Neil Boyce
    Abstract:

    One hundred ten critically ill patients with acute renal failure receiving acute Continuous Hemodiafiltration (ACHD) in our intensive care unit were studied prospectively. Acute Continuous hemodiatiltration consisted either of Continuous arteriovenous Hemodiafiltration or of Continuous veno-venous Hemodiafiltration, and was used for 17,817 hours (mean duration of patient treatment, 161.9 hours), resulting in a fall from a mean pre-ACHD urea of 35.7 mmol/L to a plateau value of 16.8 mmol/L at 72 hours of treatment. The mean urea clearance achieved was 24.9 mL/min. Eighty of these patients (72.7%) were receiving artificial ventilation at the time of ACHD and 45 (40.9%) had more than four failing organs. The mean APACHE II score was 27.7. Despite the degree of illness severity, 42 patients (32.2%) survived to discharge from hospital. The use of ACHD was associated with hemodynamic stability, rapid normalization of electrolytes, and the ability to freely administer drugs, blood, and/or blood products. It also allowed for maintenance of an aggressive, nitrogen-rich, nutritional regimen. Support of these critically ill patients with acute renal failure using ACHD was achieved safely and without the employment of additional dialysis-trained nursing staff. Our own experience and a review of the available literature strongly suggest that the advantages associated with the use of ACHD therapies are clinically significant and support the view that ACHD is a modality of renal replacement most suited to critically ill patients with acute renal failure.

  • a comparison of conventional dialytic therapy and acute Continuous Hemodiafiltration in the management of acute renal failure in the critically ill
    Renal Failure, 1993
    Co-Authors: Rinaldo Bellomo, Darren Mansfield, Stuart Rumble, Jeremy Shapiro, Geoffrey Parkin, Neil Boyce
    Abstract:

    To compare and contrast the clinical outcomes in critically ill patients with acute renal failure managed with either acute Continuous Hemodiafiltration or conventional dialytic therapies. Design: Retrospective review of the medical records of 167 consecutive cases of acute renal failure treated at a single center (July 1982-July 1991). Scoring for illness severity (APACHE II, number of failing organs) and assessment of outcome in terms of biochemical control ofazo-temia, ARF therapy-related morbidity, and overall morbidity and mortality. Setting: Tertiary institution. Patients: 767 consecutive critically ill patients with multiorgan failure and acute renal failure. Measurements and Main Results: 84 patients received conventional dialytic therapy (CDT) (1982–1988) and 83 acute Continuous Hemodiafiltration (ACHD) (1988–1991). The etiology of ARF and illness severity indices were similar in both groups (organ failure scores: CDT 3.9 vs. ACHD 4.1; NS). All patients were critically ill, with more severely ill...

  • anticoagulant regimens in acute Continuous Hemodiafiltration a comparative study
    Intensive Care Medicine, 1993
    Co-Authors: Rinaldo Bellomo, Helena J Teede, Neil Boyce
    Abstract:

    To compare and contrast different heparin regimens for extracorporeal circuit anticoagulation in patients receiving acute Continuous Hemodiafiltration (ACHD). Prospective controlled randomized comparisons of the following regimens: 1) Low dose (500 IU/h) prefilter heparin versus regional anticoagulation in patients on Continuous arteriovenous Hemodiafiltration (CAVHD) via A-V shunt. 2) Low dose pre-filter heparin versus no anticoagulation in patients receiving CAVHD via femoral cannulae. 3) Low dose pre-filter heparin versus regional anticoagulation in patients on Continuous veno-venous Hemodiafiltration (CVVHD). 4) An assessment of the consequences of the use of no anticoagulant in patients predicted to be at high risk of hemorrhagic complications on treatment with CVVHD. University Teaching Hospital ICU. 64 ICU patients with acute renal failure. Haemofilter survival during shunt CAVHD was significantly prolonged by the use of regional anticoagulation compared to the use of low dose heparin (mean filter survival: 57.1 h versus 42.9 h;p<0.05). In CAVHD using femoral cannulae, no significant differences in haemofilter survival were found between anticoagulation with low dose heparin and the use of no anticoagulant (mean filter survival: 55 h versus 52.5 h; NS). During CVVHD, regional anticoagulation compared to low dose heparin produced a trend towards prolonged filter life which was, however, not statistically significant (mean filter survival: 40.5 h versus 31.4 h; NS). In patients assessed to be at high risk of bleeding, CVVHD without anticoagulation provided a mean filter survival of 40.9 h (95% CI 27-54.8 h). Regional anticoagulation leads to longer filter survival than low dose heparin in shunt CAVHD. A regimen of no anticoagulation during femoral CAVHD leads to a filter life similar to that of low dose heparinization. During CVVHD, regional anticoagulation and low dose heparin are associated with similar filter survival times. In patients assessed to be at high risk of bleeding, treatment with CVVHD without anticoagulation results in adequate filter survival.

Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.

  • ionized serum calcium levels during acute renal failure intermittent hemodialysis vs Continuous Hemodiafiltration
    Renal Failure, 2002
    Co-Authors: Han Khim Tan, Rinaldo Bellomo, D Mpisi, Claudio Ronco
    Abstract:

    Background: Achieving “adequacy of dialysis” includes the maintenance of normal serum ionized calcium concentrations and is an important therapeutic goal in the treatment of acute renal failure (ARF). It is unknown whether this goal is best achieved with intermittent or Continuous renal replacement therapy. Methods: We compared the effects of Continuous veno–venous Hemodiafiltration (CVVHDF) and intermittent hemodialysis (IHD) on serum ionized calcium concentrations using daily morning blood tests in 88 consecutive intensive care patients of which half were treated with IHD and half with CRRT. Results: Mean patient age was 54 ± 14 years for IHD and 60 ± 14 years for CVVHDF (NS). However, patients who received CVVHDF were significantly more critically ill (mean APACHE II scores: 24.4 ± 5.1 for IHD vs. 29.2 ± 5.7 for CVVHDF, p<0.003). Before treatment, the mean ionized calcium concentration was 1.177 ± 0.03 mmol/l for IHD and 1.172 ± 0.04 mmol/l for CVVHDF (NS), with abnormal values in 51.6% of IHD patients...

  • high protein intake during Continuous Hemodiafiltration impact on amino acids and nitrogen balance
    International Journal of Artificial Organs, 2002
    Co-Authors: Rinaldo Bellomo, Han Khim Tan, S Bhonagiri, I Gopal, J Seacombe, Michael Daskalakis, N Boyce
    Abstract:

    AimsTo study the effect of combined Continuous veno-venous Hemodiafiltration (CVVHDF) and high (2.5 g/kg/day) parenteral amino acid supplementation on nitrogen balance, amino acid losses and azotemic control in a cohort of patients with severe acute renal failure (ARF).MethodsWe administered 2.5 grams/kg/day of amino acids intravenously to seven critically ill patients with ARF. We obtained paired blood and ultrafiltrate (UF) samples (n=20) and calculated amino acid clearances and losses, nitrogen balance, protein catabolic rate and total nitrogen losses.ResultsThe median total serum amino acid concentration was high at 5.2 mmol/L with particularly high concentrations of ornithine, lysine, and phenylalanine, but a low level of histidine. The median overall amino acid clearance was 18.6 ml/min (range: 12 to 29 ml/min). UF losses as percentage of administered dose were high for tyrosine (53.6 %) but low for methionine (3.0 %) and arginine (2.3 %). A positive nitrogen balance was achieved in 7 (35%) of the 2...

  • phosphatemic control during acute renal failure intermittent hemodialysis versus Continuous Hemodiafiltration
    International Journal of Artificial Organs, 2001
    Co-Authors: Han Khim Tan, Rinaldo Bellomo, D Mpisi, Claudio Ronco
    Abstract:

    BACKGROUND Achieving "adequacy of dialysis" includes the maintenance of normal serum phosphate concentrations and is an important therapeutic goal in the treatment of acute renal failure (ARF). It is unknown whether this goal is best achieved with intermittent or Continuous renal replacement therapy. METHODS We compared the effects of Continuous veno-venous Hemodiafiltration (CVVHDF) and intermittent hemodialysis (IHD) on serum phosphate concentrations using daily morning blood tests in 88 consecutive intensive care patients half of which were treated with IHD and half with CRRT RESULTS: Mean patient age was 54+/-14 years for IHD and 60+/-14 years for CVVHDF (NS). However, patients who received CVVHDF were more critically ill (mean APACHE II scores: 24.4+/-5.1 for IHD vs. 29.2+/-5.7 for CVVHDF, p<0.003). Before treatment, the serum phosphate concentration was 2.04+/-0.16 mmoll L for IHD and 1.96+/-0.17 mmoll L for CVVHDF (NS), with abnormal values in 79.4% of IHD patients and in 64.8% of CVVHDF patients (NS). During treatment, CVVHDF induced a greater reduction in serum phosphate (p=0.02) during the first 48 hours and conferred superior subsequent control of hyperphosphatemia (achieved in 64.6% of observations during CVVHDF vs. 41.8% during IHD; p<0.0001). The serum phosphate concentration was also more likely to be within the normal range during CVVHDF (55.3% vs.36.2%; p<0.0001). There was a trend toward more frequent hypophosphatemia (9.3% vs. 5.6%; P<0.1) during CVVHDF CONCLUSIONS: Abnormal serum phosphate concentrations are frequent in ARF patients before and during renal replacement, however, normalization of phosphatemia is achieved more frequently with CVVHDF.

  • severe acute renal failure a comparison of acute Continuous Hemodiafiltration and conventional dialytic therapy
    Nephron, 1995
    Co-Authors: Rinaldo Bellomo, Geoffrey Parkin, Michael Farmer, Christopher Wright, Neil Boyce
    Abstract:

    It is unknown whether Continuous renal replacement techniques result in diminished morbidity and mortality when compared to conventional dialytic techniques. To investigate this issue a previously des

  • treatment of sepsis associated severe acute renal failure with Continuous Hemodiafiltration clinical experience and comparison with conventional dialysis
    Blood Purification, 1995
    Co-Authors: Rinaldo Bellomo, Geoffrey Parkin, Michael Farmer, Christopher Wright, Neil Boyce
    Abstract:

    The syndrome of sepsis-associated severe acute renal failure is a frequent component of sepsis-induced multiorgan failure. Continuous hemofiltration techniques are often used in its dialytic managemen

Shigeto Oda - One of the best experts on this subject based on the ideXlab platform.

  • multicenter study on the consciousness regaining effect of a newly developed artificial liver support system in acute liver failure an on line Continuous Hemodiafiltration system
    Hepatology Research, 2021
    Co-Authors: Yasuhiro Takikawa, Shigeto Oda, Keisuke Kakisaka, Yuji Suzuki, Akio Ido, Tsuyoshi Shimamura, Osamu Nishida, Tooru Shimosegawa
    Abstract:

    AIM Acute liver failure (ALF) patients with coma need to be revived not only for spontaneous recovery but also as a bridge to liver transplantation. We developed a new high-volume plasma purification system using an on-line Continuous Hemodiafiltration (CHDF) system, and evaluated its safety and efficacy in a multicenter study. METHODS A single arm interventional study using the new apparatus was undertaken in the six major liver centers in Japan. The primary end-point was the proportion of patients who regained consciousness within 10 days, which was compared with a historical control (47%). Nine ALF patients were enrolled and treated with the new machine. One patient was excluded because of the need for artificial respiration support according to the established protocol. RESULTS Seven of eight (87.5%) patients regained consciousness during the on-line CHDF session, with five of those seven waking within 4 days. After waking, one patient spontaneously recovered, three received liver transplantation, two died of liver failure, and one died of another disease. The plasma ammonia levels significantly decreased after the start of on-line CHDF from 182.5 ± 64.8 μg/dL (mean ± SD) on day 0 to 87.0 ± 38.9 μg/dL on the last day of the session (P < 0.001). Similarly, the plasma glutamine level also significantly decreased from 2069 ± 1234 μmol/L to 628 ± 193 μmol/L. Although seven severe adverse events occurred during on-line-CHDF, no causal relationship with liver support was recognized. CONCLUSIONS The newly developed on-line CHDF system showed high efficacy for regain of consciousness and excellent therapeutic safety for managing ALF.

  • high recovery rate of consciousness by high volume filtrate Hemodiafiltration for fulminant hepatitis
    Hepatology Research, 2019
    Co-Authors: Keiichi Fujiwara, Ryuzo Abe, Shin Yasui, Osamu Yokosuka, Naoya Kato, Shigeto Oda
    Abstract:

    Aim An artificial liver support (ALS) system sustaining patients with acute liver failure (ALF) in good condition until recovery of the native liver or performance of liver transplantation (LT), is essential for the improvement of the poor prognosis of ALF despite the lack of survival benefit. We aimed to investigate the efficacy of various ALS systems for fulminant hepatitis (FH) carried out in our liver unit so far, focusing on the restoration of consciousness from hepatic encephalopathy. Methods One hundred and ten consecutive adult Japanese patients with FH admitted to Chiba University Hospital (Chiba, Japan) between 1988 and 2016 who received ALS were analyzed. Results Recovery rate of consciousness improved with the increased dialysate flow rate and filtrate rate: 37.5% by plasma exchange (PE), 51.9% by PE + Continuous Hemodiafiltration (CHDF), 57.7% by slow PE (sPE) + high-flow CHDF (HFCHDF) (QD = 300 mL/min), 88.6% by HFCHDF (QD = 500 mL/min) (+ sPE), and 92.9% by on-line HDF (OLHDF) (+ sPE). All patients except one, who could not be fully treated because of circulatory failure, recovered consciousness by OLHDF, including those whose liver function were completely abolished. Superiority of HFCHDF (QD = 500 mL/min) and OLHDF was also shown in patients who died without LT or received LT. Conclusions More effective ALS should be recognized considering the extremely high recovery rate of consciousness. In particular, OLHDF with predilution reduces the cost of substitution fluid by supplying an unlimited amount of dialysate as substitution fluid prepared using an on-line system, and simplifies the procedure for the management.

  • Continuous Hemodiafiltration with a cytokine adsorbing hemofilter in patients with septic shock a preliminary report
    Blood Purification, 2014
    Co-Authors: Hidetoshi Shiga, Hiroyuki Hirasawa, Nobuya Kitamura, Shigeto Oda, Masataka Nakamura, Kunihiro Mashiko, Osamu Nishida, Kenich Matsuda, Yoshihiko Kikuchi, Nobuo Fuke
    Abstract:

    Background/Aim: We investigated the clinical efficacy of Continuous Hemodiafiltration (CHDF) with AN69ST hemofilter (AN69ST-CHDF) in patients with septic shock. Materials and Methods: A prospective, multicenter, single-arm study was conducted. Patients with sepsis and shock defined by hyperlactemia were enrolled. The patients were treated with CHDF and in accordance with the Surviving Sepsis Campaign guidelines (SSCG). Results: Thirty-four patients were enrolled. On ICU admission, the mean blood IL-6 level was 44,800 ± 77,700 pg/ml, and the mean blood lactate level was 69.0 ± 49.4 mg/dl. Both the mean blood IL-6 and lactate levels had significantly decreased to normal ranges after 72 h of AN69ST-CHDF. Though the mean APACHE II score was 32.7 ± 9.8, 28-day survival was 73.5%. Conclusion: The current study suggested that adding AN69ST-CHDF to the treatments outlined in the SSCG might lead to good outcomes for patients with septic shock, probably via the removal of cytokines from the bloodstream.

  • Continuous Hemodiafiltration with a cytokine adsorbing hemofilter for sepsis
    Blood Purification, 2012
    Co-Authors: Hiroyuki Hirasawa, Shigeto Oda, Hidetoshi Shiga, Masataka Nakamura, Eizo Watanabe, Kenichi Matsuda
    Abstract:

    Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume Continuous hemofiltration whose efficacy has recently been questioned. We report that Continuous Hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.

  • efficacy of Continuous Hemodiafiltration with a cytokine adsorbing hemofilter in the treatment of acute respiratory distress syndrome
    Contributions To Nephrology, 2010
    Co-Authors: Kenichi Matsuda, Shigeto Oda, Takeshi Moriguchi, Hiroyuki Hirasawa
    Abstract:

    Background/Aims: In the pathophysiology of acute respiratory distress syndrome (ARDS), the increase in capillary and alveolar permeability caused by various humoral mediators and re

Hiroyuki Hirasawa - One of the best experts on this subject based on the ideXlab platform.

  • Continuous Hemodiafiltration with a cytokine adsorbing hemofilter in patients with septic shock a preliminary report
    Blood Purification, 2014
    Co-Authors: Hidetoshi Shiga, Hiroyuki Hirasawa, Nobuya Kitamura, Shigeto Oda, Masataka Nakamura, Kunihiro Mashiko, Osamu Nishida, Kenich Matsuda, Yoshihiko Kikuchi, Nobuo Fuke
    Abstract:

    Background/Aim: We investigated the clinical efficacy of Continuous Hemodiafiltration (CHDF) with AN69ST hemofilter (AN69ST-CHDF) in patients with septic shock. Materials and Methods: A prospective, multicenter, single-arm study was conducted. Patients with sepsis and shock defined by hyperlactemia were enrolled. The patients were treated with CHDF and in accordance with the Surviving Sepsis Campaign guidelines (SSCG). Results: Thirty-four patients were enrolled. On ICU admission, the mean blood IL-6 level was 44,800 ± 77,700 pg/ml, and the mean blood lactate level was 69.0 ± 49.4 mg/dl. Both the mean blood IL-6 and lactate levels had significantly decreased to normal ranges after 72 h of AN69ST-CHDF. Though the mean APACHE II score was 32.7 ± 9.8, 28-day survival was 73.5%. Conclusion: The current study suggested that adding AN69ST-CHDF to the treatments outlined in the SSCG might lead to good outcomes for patients with septic shock, probably via the removal of cytokines from the bloodstream.

  • Continuous Hemodiafiltration with a cytokine adsorbing hemofilter for sepsis
    Blood Purification, 2012
    Co-Authors: Hiroyuki Hirasawa, Shigeto Oda, Hidetoshi Shiga, Masataka Nakamura, Eizo Watanabe, Kenichi Matsuda
    Abstract:

    Since the introduction of the new pathophysiological concept of pathogen-associated molecular patterns (PAMPS) and alarmins, endotoxin has been recognized as only one of the PAMPS. It is widely accepted that hypercytokinemia plays a pivotal role in the pathophysiology of sepsis. Many kinds of blood purification modalities have been proposed as a therapeutic tool against sepsis, including high-volume Continuous hemofiltration whose efficacy has recently been questioned. We report that Continuous Hemodiafiltration (CHDF) with a cytokine-adsorbing hemofilter (CAH), such as polymethyl methacrylate hemofilter and AN69ST hemofilter (CAH-CHDF), can remove many kinds of cytokines and has been very effective in the treatment of severe sepsis and septic shock. Based on the understanding of the recent pathophysiology, we suggest that CAH-CHDF is an alternate therapy to direct hemoperfusion with endotoxin-adsorbing column in the treatment of sepsis.

  • efficacy of Continuous Hemodiafiltration with a cytokine adsorbing hemofilter in the treatment of acute respiratory distress syndrome
    Contributions To Nephrology, 2010
    Co-Authors: Kenichi Matsuda, Shigeto Oda, Takeshi Moriguchi, Hiroyuki Hirasawa
    Abstract:

    Background/Aims: In the pathophysiology of acute respiratory distress syndrome (ARDS), the increase in capillary and alveolar permeability caused by various humoral mediators and re

  • Continuous Hemodiafiltration in the treatment of reactive hemophagocytic syndrome refractory to medical therapy
    Transfusion and Apheresis Science, 2009
    Co-Authors: Yoshihisa Tateishi, Shigeto Oda, Masataka Nakamura, Tomohito Sadahiro, You Hirayama, Ryuzo Abe, Hiroyuki Hirasawa
    Abstract:

    Abstract Reactive (or secondary) hemophagocytic syndrome (RHS) is a potentially lethal condition and characterized by hypercytokinemia. Immune modulating drugs sometimes fail to achieve satisfactory control. Therefore we investigate the efficacy of Continuous Hemodiafiltration using a polymethyl methacrylate membrane hemofilter (PMMA-CHDF) for cytokine removal in patients with RHS. Eight consecutive patients who admitted to our ICU with RHS complicating organ failures and refractory to medical therapy were initiated intensive care including PMMA-CHDF. Although remission was achieved in six patients, remaining two patients died of exacerbation of underlying diseases. Changes in blood levels of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) as indices of cytokine network activation, and serum ferritin level as an index of severity of RHS were investigated during PMMA-CHDF. PMMA-CHDF performed for 3days significantly reduced blood TNF-α level (183±159pg/ml to 84±98pg/ml, p p p

  • the role of hypercytokinemia in the pathophysiology of tumor lysis syndrome tls and the treatment with Continuous Hemodiafiltration using a polymethylmethacrylate membrane hemofilter pmma chdf
    Transfusion and Apheresis Science, 2009
    Co-Authors: Masataka Nakamura, Shigeto Oda, Yoshihisa Tateishi, Ryuzo Abe, Tomohoto Sadahiro, Yoh Hirayama, Hiroyuki Hirasawa
    Abstract:

    Abstract Objective To examine the role of hypercytokinemia in the pathophysiology of tumor lysis syndrome (TLS) and the efficacy of Continuous Hemodiafiltration in the treatment of TLS. Design and setting Retrospective observational study in a general intensive care unit of a university hospital. Patients Four patients with hematological disorder developing TLS after the treatment of anti-tumor chemotherapy. Interventions Continuous Hemodiafiltration using a polymethylmethacrylate membrane hemofilter (PMMA-CHDF) was performed at the onset of TLS. Blood samples were collected daily after ICU admission, and clinical parameters and blood levels of cytokines were evaluated. Measurements and results All four patients underwent induction anti-tumor chemotherapy, during which they developed hyperuricemia, hyperkalemia, and acute renal failure. Two of them also developed multiple organ failure. Serum levels of tumor necrosis factor (TNF) -alpha, interleukin-6 (IL-6), and IL-10 prior to the initiation of PMMA-CHDF were 102±85pg/mL, 1097±546pg/mL, and 98±83pg/mL, respectively (mean ± SD). After three days of PMMA-CHDF treatment, corresponding blood levels were 37±55pg/mL, 326±511pg/mL, and 9±8pg/mL, respectively. Thus, all cytokine levels were significantly decreased by three days of PMMA-CHDF treatment ( p t -test). Following three days of PMMA-CHDF treatment, blood urea nitrogen (BUN) and serum creatinine (Cre.) were significantly decreased (pre/post BUN 42.3±15.4/16.5±8.4mg/dL, p p Conclusion Hypercytokinemia plays a pivotal role in the pathophysiology of TLS and PMMA-CHDF may be an effective therapeutic modality for TLS patients not only as renal replacement therapy but also as a cytokine modulator.

Kenichi Matsuda - One of the best experts on this subject based on the ideXlab platform.