COVID-19 Cytokine Storms: Nephrologists Invent New Blood Filters For Use In Dialysis Machines To Remove Cytokines In COVID-19 Patients
Source: COVI19 Cytokine Storms May 05, 2020 4 years, 6 months, 1 week, 1 day, 20 hours, 27 minutes ago
COVID-19 Cytokine Storms: Two nephrologists have invented a blood filter that can be used in standard kidney dialysis machines to remove cytokines that are created during an infection with the SARS-CoV-2 coronavirus.
It has been observed that cytokine storms created by COVID-19 are causing major organ destruction and death, and for the first time in America, when patients begin to show signs of trouble, doctors are replacing the usual filter in a kidney dialysis machine with a filter known to trap these tiny proteins, with the goal of avoiding the devastation.
Dr Azeem Mohammed (left) and Dr Sandeep Padala
Credit: Phil Jones, Snr Photographer, Augusta University
Dr Azeem Mohammed, nephrologist at the Medical College of Georgia and Augusta University Health System told Thailand Medical News, "Cytokines are supposed to destroy the novel coronavirus, but there is such a high level of cytokines that they are actually destroying organs."
Together with his colleague Dr Sandeep Padala, also a nephrologist at MCG and the AU Health System, the two were already working with patients with COVID-19 who, like many critically ill patients, needed dialysis because their kidneys were failing.
The two medical experts wondered if dialysis could also be used much earlier in the disease course to cleanse the blood of excessive, destructive cytokines and stop the damage to the kidneys and other organs.
Collaborating with Deerfield, an Illinois-based medical products company and Baxter International Inc which supplies the hemodialysis machines used in the intensive care units at AU Health System, they explored developing a filter that could trap cytokines.
Together they utilized the Oxiris filter set, which has been used for more than a decade in Europe and Asia, and works like a sponge to capture and absorb cytokines along with toxins released by bacteria called endotoxins which also induce cytokines, as well as toxins typically filtered by the kidneys called uremic toxins.
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Similar to standard kidney dialysis filters, these also filter excess fluid and contain the blood thinner heparin, which can reduce clots, another concern with this novel viral infection, in which strokes also are being reported even in young people.
Baxter International quickly responded by seeking and securing emergency use authorization from the Food and Drug Administration for the filter's use in the US for COVID-19. Its use in Europe and Asia includes treating sepsis, another overwhelming and typically bacterial infection that also produces a
cytokine storm.
For the last 8 days, when patients show signs of significant respiratory problems and are headed to intensive care, Dr Mohammed and Dr Padala are using this blood filter for up to 72 hours, the outside limit for the life of a filter.
The two medical researchers had assessed cytokine levels before the new therapy, then at 24 and 48 hours upon the ‘special dialysis’ to look at trends and assess how the patients are doing clinically. The nephrologists found cytokine levels had fallen and the clinical status improving. While they are not yet conducting a clinical trial, they are collecting this kind of data on patients as well as comparative data on similar patients, who were treated before the availability of the filter, and have begun steps to enable a traditional, clinical trial for their treatment of the COVID-19 disease..
Dr Padala commented, "If we can come in early in the disease process, our hypothesis is that patients will not do so poorly, they will not have so much organ dysfunction, they will probably have less clotting, less ARDS, less kidney failure."
Adult respiratory distress syndrome or ARDS is a leading cause of death from COVID-19, in which cytokines as well as the virus attack the lungs, and a clear indicator that more trouble is ahead.
Dr Padala further added, "We believe that with this new approach, you basically are not waiting for all these disasters to happen. If we can cut down the cytokine storm, we are avoiding all those things which should mean a shorter, less traumatic and less deadly disease course.”
Both medical experts are optimistic as well about the safety of the procedure, which requires ultrasound-guided temporary placement of a catheter into an internal jugular vein. The jugular vein is now the preferred placement site for kidney dialysis as well, and the potential acute risks are essentially the same as those for kidney dialysis, including bleeding, infection and collapsed lung, or pneumothorax. A documented allergy to heparin is the only absolute contraindication for using the new therapy.
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