DOI: 10.2169/internalmedicine.2708-23
As the incidence of severe acute pancreatitis (SAP) increasingly demands the attention of healthcare systems worldwide, the quest for effective management strategies remains paramount. In a groundbreaking study entitled “A Retrospective Study on the Start and End of Continuous Hemodialysis using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis,” published in the journal Internal Medicine, researchers from Okinawa Kyodo Hospital in Japan have provided critical insights that could revolutionize how medical professionals approach treatment for one of the most dangerous forms of this disease.
This study meticulously evaluated 63 patients diagnosed with SAP who were admitted to the intensive-care unit from January 1, 2011, to December 31, 2022. It primarily focused on 30 patients among them who underwent continuous hemodialysis using a polymethylmethacrylate hemofilter (PMMA-CHD) due to renal dysfunction, a grave complication of SAP.
The retrospective analysis conducted by the team led by Kinjoh Kiyohiko, along with colleagues Nagamura Ryoji and Sakuda Yutaka, sought to identify the optimal timing for initiating and terminating PMMA-CHD therapy—a form of blood purification therapy. By analyzing various severity scores, including prognostic factor scores in the Japanese severity criteria, Kidney Disease: Improving Global Outcomes (KDIGO) stage, and the lung injury score (LIS), the research presents statistically significant findings pertinent to clinical decision-making.
Results from the study unveiled that at the point of blood purification therapy commencement using PMMA-CHD, there was a noteworthy escalation in the KDIGO stage, with a determined cutoff value of 2.0. This finding suggests that a higher stage of kidney injury indicates an imminent need for hemodialysis intervention.
Compellingly, both the prognostic factor score and the LIS at the initiation of blood purification therapy were considerably elevated. The researchers found that these indicators had to reach significant cutoff values—3.0, in this case—before recommending PMMA-CHD initiation.
The analysis also highlighted the improvements in prognostic values post-commencement of PMMA-CHD therapy. The KDIGO stage, after starting therapy, significantly decreased with a cutoff value of -2.0. Similarly, the prognostic factor score drastically reduced, underscoring the efficacy of PMMA-CHD in patient recovery.
The conclusion drawn from this comprehensive study suggests that the prognostic factor scores based on the Japanese severity criteria and LIS, as well as the KDIGO stage, are invaluable in dictating the initiation and cessation of PMMA-CHD therapy in SAP cases. These findings hold the promise of improving outcomes for patients with SAP by providing clinically relevant parameters for timely intervention.
References
1. Kinjoh, K., Nagamura, R., & Sakuda, Y. (2024). A Retrospective Study on the Start and End of Continuous Hemodialysis using a Polymethylmethacrylate Hemofilter for Severe Acute Pancreatitis. Internal Medicine (Tokyo, Japan). doi:10.2169/internalmedicine.2708-23
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Keywords
1. Severe Acute Pancreatitis Treatment
2. Continuous Hemodialysis SAP
3. PMMA Hemofilter Pancreatitis
4. Acute Kidney Injury Management
5. Prognostic Factor Scores Pancreatitis