Extracorporeal treatment for tricyclic antidepressant poisoning: recommendations from the EXTRIP Workgroup.


:The Extracorporeal Treatments In Poisoning (EXTRIP) workgroup was formed to provide recommendations on the use of extracorporeal treatments (ECTR) in poisoning. Here, the workgroup presents its results for tricyclic antidepressants (TCAs). After an extensive literature search, using a predefined methodology, the subgroup responsible for this poison reviewed the articles, extracted the data, summarized findings, and proposed structured voting statements following a predetermined format. A two-round modified Delphi method was chosen to reach a consensus on voting statements and RAND/UCLA Appropriateness Method to quantify disagreement. Blinded votes were compiled, returned, and discussed in person at a meeting. A second vote determined the final recommendations. Seventy-seven articles met inclusion criteria. Only case reports, case series, and one poor-quality observational study were identified yielding a very low quality of evidence for all recommendations. Data on 108 patients, including 12 fatalities, were abstracted. The workgroup concluded that TCAs are not dialyzable and made the following recommendation: ECTR is not recommended in severe TCA poisoning (1D). The workgroup considers that poisoned patients with TCAs are not likely to have a clinical benefit from extracorporeal removal and recommends it NOT to be used in TCA poisoning.


Semin Dial


Seminars in dialysis


Yates C,Galvao T,Sowinski KM,Mardini K,Botnaru T,Gosselin S,Hoffman RS,Nolin TD,Lavergne V,Ghannoum M,EXTRIP workgroup.




Has Abstract


2014-07-01 00:00:00












  • Blood Pressure Management in Hemodialysis Patients: What We Know And What Questions Remain.

    abstract::Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Miskulin DC,Weiner DE

    更新日期:2017-05-01 00:00:00

  • Laughter and humor therapy in dialysis.

    abstract::Laughter and humor therapy have been used in health care to achieve physiological and psychological health-related benefits. The application of these therapies to the dialysis context remains unclear. This paper reviews the evidence related to laughter and humor therapy as a medical therapy relevant to the dialysis pa...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Bennett PN,Parsons T,Ben-Moshe R,Weinberg M,Neal M,Gilbert K,Rawson H,Ockerby C,Finlay P,Hutchinson A

    更新日期:2014-09-01 00:00:00

  • Ultrapure dialysate.

    abstract::To prevent pyrogenic reactions during hemodialysis, it is recommended that bacteria and endotoxin in dialysate not exceed 100-200 colony forming units (CFU)/ml and 0.25-2 endotoxin units (EU)/ml, respectively. While these limits are adequate to prevent acute pyrogenic reactions, data are accumulating to suggest they m...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Ward RA

    更新日期:2004-11-01 00:00:00

  • Are Diuretics Underutilized in Dialysis Patients?

    abstract::While oral diuretics are commonly used in patients with chronic kidney disease for the management of volume and blood pressure, they are often discontinued upon initiation of dialysis. We suggest that diuretics are considerably underutilized in peritoneal dialysis and haemodialysis patients despite numerous potential ...

    journal_title:Seminars in dialysis

    pub_type: 社论


    authors: Trinh E,Bargman JM

    更新日期:2016-09-01 00:00:00

  • Pathogenic effects of a high peritoneal transport rate.

    abstract::Recent studies have shown that patients with high peritoneal transport characteristics have substantially increased morbidity and mortality. This finding is counter-intuitive, since HTs will a priori achieve higher clearances. There are many possible causes: increased protein losses with consequent hypoalbuminemia; po...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Heaf J

    更新日期:2000-05-01 00:00:00

  • Serum Parathyroid Hormone Concentrations and Clinical Outcomes in ESRD: A Call for Targeted Clinical Trials.

    abstract::Secondary hyperparathyroidism almost universally accompanies end-stage renal disease (ESRD). In some, but not all studies, elevated serum parathyroid hormone (PTH) concentrations are associated with increased fracture rates, cardiovascular disease, and mortality in ESRD. The serum concentration of PTH required for opt...

    journal_title:Seminars in dialysis

    pub_type: 社论


    authors: Zand L,Kumar R

    更新日期:2016-05-01 00:00:00

  • The psychiatric landscape of withdrawal.

    abstract::Withdrawal from dialysis is an appropriate decision for situations in which the burdens of treatment outweigh the benefits. Alternately, it can be viewed as a public health problem and suicide equivalent that contributes to the high mortality of end-stage renal disease (ESRD). More than one in five deaths of patients ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Cohen LM,Germain MJ

    更新日期:2005-03-01 00:00:00

  • In-center thrombolysis for clotted AV access: a cohort review.

    abstract::Thrombosis is the leading cause of arteriovenous (AV) access failure for hemodialysis patients requiring frequent interventions. We describe a novel approach to the lyse-and-wait technique in thrombosed AV access using nurse-administered thrombolytics in a hospital-based hemodialysis unit. All patients at a single-cen...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Umanath K,Morrison RS,Christopher Wilbeck J,Schulman G,Bream P,Dwyer JP

    更新日期:2013-01-01 00:00:00

  • Strategy for maximizing the use of arteriovenous fistulae.

    abstract::Increasing the use of arteriovenous fistulae in dialysis patients requires a specific strategy. In order to properly select patients for an arteriovenous fistula (AVF), it is essential that the nephrologist become knowledgeable about the subject and that an organized approach be followed. Both the arterial and venous ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Beathard GA

    更新日期:2000-09-01 00:00:00

  • The association of hepatitis C infection with the onset of CKD and progression into ESRD.

    abstract::Hepatitis C virus (HCV) infection is not only an important cause of chronic liver disease, but extrahepatic manifestations are common and include chronic kidney disease (CKD). HCV is classically associated with cryoglobulinemic glomerulonephritis in the context of mixed cryoglobulinemia syndrome, but other glomerular ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Henson JB,Sise ME

    更新日期:2019-03-01 00:00:00

  • Similar outcomes of catheters implanted by nephrologists and surgeons: analysis of the Brazilian peritoneal dialysis multicentric study.

    abstract::A good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,多中心研究


    authors: de Moraes TP,Campos RP,de Alcântara MT,Chula D,Vieira MA,Riella MC,Olandowski M,Divino-Filho JC,Pecoits-Filho R,Investigators of BRAZPD.

    更新日期:2012-09-01 00:00:00

  • Tunneled Hemodialysis Catheter Removals by Non-Interventional Nephrologists: The University of Mississippi Experience.

    abstract::Bedside removal of tunneled hemodialysis catheters (TDC) by noninterventional Nephrologists has not been frequently performed or studied. We performed a retrospective review of bedside TDC removal at the University of Mississippi Medical Center between January, 2010 and June, 2013. We collected data on multiple patien...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Fülöp T,Rodríguez B,Kosztaczky BA,Gharaibeh KA,Lengvárszky Z,Dossabhoy NR,Tapolyai MB

    更新日期:2015-09-01 00:00:00

  • Cardiovascular abnormalities and hypertension in the elderly dialysis patient.

    abstract::Elderly individuals comprise an ever-increasing proportion of patients on renal replacement therapy (RRT). As in younger patients, cardiovascular events are the major cause of death in the elderly on RRT, although the relative proportion succumbing to cardiovascular events is similar to that in young patients. An impo...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Dikow R,Zeier M,Ritz E

    更新日期:2002-03-01 00:00:00

  • Hemodialysis for the treatment of severe accidental hypothermia.

    abstract::Severe hypothermia is defined as a core body temperature <28°C and is associated with in-hospital mortality rates of 50% or higher. Delays in rewarming and slower rates of rewarming are the most important prognostic factors associated with increased mortality. Arrhythmias are the most common cause of mortality in pati...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Singh T,Hallows KR

    更新日期:2014-05-01 00:00:00

  • The relation between epicardial fat tissue thickness and atrial fibrillation ın hemodialysis patients.

    abstract::The prevalence of arrhythmia has increased in hemodialysis (HD) patients and the most frequent is atrial fibrillation (AF). It was reported that the amount of epicardial fat tissue (EFT) in the population without renal disease is closely related to AF. In the present study of ours, the relation between EFT thickness a...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Guzel FB,Altunoren O,Gunes H,Seyithanoglu M,Kerkutluoglu M,Sezal DT,Gungor O

    更新日期:2020-09-01 00:00:00

  • Immunosuppressive management of dialysis patients with recently failed transplants.

    abstract::Over the past decade, patients returning to dialysis after a failed transplant comprised of 5-10% of the annual number of dialysis initiations in the United States, whereas retransplant candidates account for 5.0-13% of the annual deceased donor wait-list additions. The United States Renal Data System (USRDS) database...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Pham PT,Pham PC

    更新日期:2011-05-01 00:00:00

  • Consolidation in dialysis Markets-Causes, consequences, and the role of policy.

    abstract::The dialysis industry is one of the most highly concentrated healthcare sectors in the United States. Despite decades of growth in the number of patients with end-stage renal disease and in the size of dialysis markets, two large dialysis organizations currently care for more than two-thirds of the dialysis population...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Saeed MK,Ho V,Erickson KF

    更新日期:2020-01-01 00:00:00

  • A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis.

    abstract:INTRODUCTION:Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure. METHODS:Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters st...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Jothi S,Kg H,Lesley N,Vijayan M,Haridas Anupama S,Mathew M,Parthasarathy R,Sundarajan S,P N,Kumaraswamy L,Abraham G

    更新日期:2020-09-01 00:00:00

  • Inflammatory biomarkers and cardiovascular risk: association or cause and effect?

    abstract::With the current understanding that atherosclerosis is an inflammatory disorder, markers of the associated systemic inflammatory response have been extensively studied as predictors of cardiovascular disease. Recently the use of high-sensitivity C-reactive protein (hsCRP) has been proposed for risk assessment in indiv...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Rao M,Jaber BL,Balakrishnan VS

    更新日期:2006-03-01 00:00:00

  • Timing of dialysis initiation in acute kidney injury and acute-on-chronic renal failure.

    abstract::The decision to provide dialytic support and choosing the ideal moment to initiate therapy are common impasses for physicians treating patients with acute kidney injury (AKI). Although renal replacement therapy (RRT) has been extensively used in clinical practice for more than 30 years, there is a paucity of evidence ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Macedo E,Mehta RL

    更新日期:2013-11-01 00:00:00

  • Intradialytic hypotension: an overview of recent, unresolved and overlooked issues.

    abstract::The etiology and management of intradialytic hypotension has become an increasingly complex issue. Volume depletion due to ultrafiltration remains the predominant underlying etiologic factor. However, patients vary markedly in their hemodynamic tolerance to fluid removal. While many risk factors have been identified, ...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Sherman RA

    更新日期:2002-05-01 00:00:00

  • Cardiovascular disease in chronic renal failure: pathophysiologic aspects.

    abstract::Cardiovascular complications are the leading cause of mortality in patients with end-stage renal disease (ESRD). The excess cardiovascular risk and mortality is already demonstrable in early renal disease and in patients with chronic renal failure (CRF), with the highest relative risk of mortality in the youngest pati...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: London GM

    更新日期:2003-03-01 00:00:00

  • Dietary phosphorus restriction in advanced chronic kidney disease: merits, challenges, and emerging strategies.

    abstract::Hyperphosphatemia is an independent risk factor for mortality in patients on maintenance dialysis. Since phosphorus clearance by standard three times-weekly dialysis is insufficient to balance ongoing dietary phosphorus intake, strategies to prevent absorption of dietary phosphorus are essential for attenuating increa...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Gutiérrez OM,Wolf M

    更新日期:2010-07-01 00:00:00

  • Thigh grafts: a preferable alternative to catheters when upper extremity access sites are exhausted.

    abstract::Hemodialysis patients with failed upper extremity (arm) access sites comprise 5-10% of the dialysis population. In these patients, arm vessels are either unsuitable for access placement due to trauma or peripheral vascular disease, or have been exhausted following dialysis usage. Synthetic grafts in the lower extremit...

    journal_title:Seminars in dialysis

    pub_type: 社论


    authors: Abreo KD,Ram SJ

    更新日期:2009-09-01 00:00:00

  • Sonography of Arteriovenous Fistulas and Grafts.

    abstract::Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are the vascular accesses of choice for long-term hemodialysis. Strategies to establish and maintain functioning AVFs and AVGs are essential. In addition to clinical evaluation, ultrasound plays a critical role in the evaluation and maintenance of AVFs and ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Pietryga JA,Little MD,Robbin ML

    更新日期:2017-07-01 00:00:00

  • What is so bad about reverse epidemiology anyway?

    abstract::The term "reverse epidemiology" is used to indicate that such surrogates of cardiovascular risk and metabolic syndrome as obesity, hypercholesterolemia and hypertension are paradoxically associated with greater survival in individuals with chronic disease states and wasting, including dialysis patients, in whom the sh...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Kalantar-Zadeh K

    更新日期:2007-11-01 00:00:00

  • Blood pressure control in conventional hemodialysis.

    abstract::Hypertension among patients on hemodialysis is common, difficult to diagnose and often inadequately controlled. Although specific blood pressure (BP) targets in this particular population are not yet established, meta-analyses of randomized trials showed that deliberate BP-lowering with antihypertensive drugs improves...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章,评审


    authors: Georgianos PI,Agarwal R

    更新日期:2018-11-01 00:00:00

  • Mycotic aneurysms and death in a hemodialysis patient.

    abstract::A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, b...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Chang CS,Thajeb P,Chen HH,Wu CJ

    更新日期:2005-07-01 00:00:00

  • Outcomes of arteriovenous grafts following simultaneous thrombectomy and stent graft placement across the venous anastomosis.

    abstract::Arteriovenous grafts (AVGs) suffer from high thrombosis rates. It is not known whether placement of stent grafts at the venous anastomosis (VA) of thrombosed AVGs would impact future thrombosis. This is a retrospective study evaluating a group of AVGs that underwent endovascular thrombectomy with placement of a stent ...

    journal_title:Seminars in dialysis

    pub_type: 杂志文章


    authors: Nassar GM,Suki D,Rhee E,Khan AJ,Nguyen B,Achkar K

    更新日期:2014-11-01 00:00:00

  • Euvolemia-A critical target in the management of acute kidney injury.

    abstract::It has been clearly established that critically ill patients with sepsis require prompt fluid resuscitation. The optimal amount of fluid and when to taper this resuscitation is less clear. There is a growing evidence that fluid overload leads to acute kidney injury, and increased morbidity and mortality. A clinician's...

    journal_title:Seminars in dialysis

    pub_type: 社论,评审


    authors: Colbert GB,Szerlip HM

    更新日期:2019-01-01 00:00:00