Summary: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, other enzyme preparations (e.g., gel-entrapped microsomes, membrane-free enzymes bound to artificial carriers), or other adsorbents (e.g., various resins, albumin-conjugated agarose).

Top Publications

  1. Shoji H. Extracorporeal endotoxin removal for the treatment of sepsis: endotoxin adsorption cartridge (Toraymyxin). Ther Apher Dial. 2003;7:108-14 pubmed
    ..Further studies are now ongoing to establish Toraymyxin treatment as one of the options to treat sepsis and septic shock patients and to clarify the mechanisms involved in this therapy. ..
  2. Nakamura T, Ushiyama C, Suzuki Y, Shoji H, Shimada N, Koide H. Hemoperfusion with polymyxin B immobilized fibers for urinary albumin excretion in septic patients with trauma. ASAIO J. 2002;48:244-8 pubmed
    ..Plasma endotoxin levels were determined by endospecy test. Hemoperfusion with PMX-F was carried out twice, for 2 hours, at a flow rate of 100 ml/min...
  3. Nakamura T, Ushiyama C, Suzuki Y, Inoue T, Shoji H, Shimada N, et al. Combination therapy with polymyxin B-immobilized fibre haemoperfusion and teicoplanin for sepsis due to methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2003;53:58-63 pubmed
    ..001). The mean duration of stay was 44, 42, 28 and 56 days in groups A, B, C and D, respectively. Our data suggest that combination therapy with PMX-F and teicoplanin is effective for sepsis caused by MRSA. ..
  4. Ikeda T, Ikeda K, Nagura M, Taniuchi H, Matsushita M, Kiuchi S, et al. Clinical evaluation of PMX-DHP for hypercytokinemia caused by septic multiple organ failure. Ther Apher Dial. 2004;8:293-8 pubmed
    ..These results suggest that PMX-DHP could save more lives in patients with septic multiple organ failure with IL-6 = 1000 pg/mL when applied early after the onset of shock. ..
  5. López Lago A, Rivero Velasco C, Galban Rodríguez C, Mariño Rozados A, Piñeiro Sande N, Ferrer Vizoso E. [Paraquat poisoning and hemoperfusion with activated charcoal]. An Med Interna. 2002;19:310-2 pubmed
    ..with orogastric lavage, activated charcoal, N-acetylcysteine, Fuller's earth, cathartics, support measures and hemoperfusion with activated charcoal...
  6. Ikeda T. Hemoadsorption in critical care. Ther Apher. 2002;6:189-92 pubmed
    ..These results suggest favorable effects of endotoxin hemoadsorption on the hemodynamic and pathophysiological conditions in patients with septic shock although attention should be given to the decrease in platelet count. ..
  7. Castro R, Prata C, Oliveira L, Carvalho M, Santos J, Carvalho F, et al. [Paraquat intoxication and hemocarboperfusion]. Acta Med Port. 2005;18:423-31 pubmed
    ..04). Hemoperfusion with activated charcoal was performed after December 1997 until June 2004 for 25 patients...
  8. Ronco C, Piccinni P, Kellum J. Rationale of extracorporeal removal of endotoxin in sepsis: theory, timing and technique. Contrib Nephrol. 2010;167:25-34 pubmed publisher
    ..This can be achieved today with a very specific hemoperfusion process utilizing cartridges with immobilized polymixin B in an extracorporeal circuit...
  9. Kohro S, Imaizumi H, Yamakage M, Masuda Y, Namiki A, Asai Y, et al. Anandamide absorption by direct hemoperfusion with polymixin B-immobilized fiber improves the prognosis and organ failure assessment score in patients with sepsis. J Anesth. 2006;20:11-6 pubmed
    Direct hemoperfusion (DHP) with polymixin B-immobilized fiber (PMX) has been reported to be effective for patients with septic shock. The aim of this study was to clarify the mechanism of PMX-DHP effect on septic shock...

More Information


  1. Uriu K, Osajima A, Hiroshige K, Watanabe H, Aibara K, Inada Y, et al. Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock. Am J Kidney Dis. 2002;39:937-47 pubmed
    Direct hemoperfusion (DHP) with an adsorbent column using polymyxin B-immobilized fiber (PMX-F) has been shown to improve the state of shock in patients with septic shock...
  2. Ueno T, Sugino M, Nemoto H, Shoji H, Kakita A, Watanabe M. Effect over time of endotoxin adsorption therapy in sepsis. Ther Apher Dial. 2005;9:128-36 pubmed
    ..In recent years, endotoxin adsorption therapy (PMX-DHP, polymyxin-direct hemoperfusion) has been widely used in Japan to remove endotoxin, a causative agent of sepsis...
  3. Koo J, Kim J, Yoon J, Kim G, Jeon R, Kim H, et al. Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning. Am J Kidney Dis. 2002;39:55-9 pubmed
    ..The amount ingested was 2.1 +/- 1.0 mouthfuls (as 20% concentrate). All patients were treated with hemoperfusion (HP; duration, 6.4 +/- 3...
  4. Kojika M, Sato N, Yaegashi Y, Suzuki Y, Suzuki K, Nakae H, et al. Endotoxin adsorption therapy for septic shock using polymyxin B-immobilized fibers (PMX): evaluation by high-sensitivity endotoxin assay and measurement of the cytokine production capacity. Ther Apher Dial. 2006;10:12-8 pubmed
    ..The 28-day mortality rate was 12%. PMX-direct hemoperfusion (PMX-DHP) was associated with elevation of the mean arterial pressure and urine output, reduction in the mean ..
  5. Nakamura T, Kawagoe Y, Matsuda T, Shoji H, Ueda Y, Tamura N, et al. Effect of polymyxin B-immobilized fiber on blood metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 levels in acute respiratory distress syndrome patients. Blood Purif. 2004;22:256-60 pubmed
    ..01, TIMP-1 220.6 +/- 30.5 ng/ml, p < 0.01). These data suggest that MMP-9 and TIMP-1 may play a role in the pathogenesis of ARDS and that PMX-F treatment ameliorated increased MMP-9 and TIMP-1 levels in ARDS patients. ..
  6. Nakamura T, Ushiyama C, Suzuki Y, Osada S, Inoue T, Shoji H, et al. Hemoperfusion with polymyxin B-immobilized fiber in septic patients with methicillin-resistant Staphylococcus aureus-associated glomerulonephritis. Nephron Clin Pract. 2003;94:c33-9 pubmed
    ..PMX-F treatment may be effective in reducing urinary protein and urinary podocyte excretion in septic patients with MRSA-associated glomerulonephritis. ..
  7. Nakamura T, Kawagoe Y, Matsuda T, Ebihara I, Koide H. Effects of polymyxin B-immobilized fiber hemoperfusion on amino acid imbalance in septic encephalopathy. Blood Purif. 2003;21:282-6 pubmed
    ..acids is altered in patients with septic encephalopathy and whether polymyxin B-immobilized fiber (PMX-F) hemoperfusion affects this balance...
  8. Kushi H, Miki T, Okamaoto K, Nakahara J, Saito T, Tanjoh K. Early hemoperfusion with an immobilized polymyxin B fiber column eliminates humoral mediators and improves pulmonary oxygenation. Crit Care. 2005;9:R653-61 pubmed
    The objective of this study was to clarify the efficacy and mechanism of action of direct hemoperfusion with an immobilized polymyxin B fiber column (DHP-PMX) in patients with acute lung injury or acute respiratory distress syndrome ..
  9. Vincent J, Laterre P, Cohen J, Burchardi H, Bruining H, Lerma F, et al. A pilot-controlled study of a polymyxin B-immobilized hemoperfusion cartridge in patients with severe sepsis secondary to intra-abdominal infection. Shock. 2005;23:400-5 pubmed
    Endotoxin is an important pathogenic trigger for sepsis. The polymyxin B-immobilized endotoxin removal hemoperfusion cartridge, Toraymyxin (hereafter PMX), has been shown to remove endotoxin in preclinical and open-label clinical studies...
  10. Uriu K, Osajima A, Kamochi M, Watanabe H, Aibara K, Kaizu K. The severity of hyperdynamic circulation may predict the effects of direct hemoperfusion with the adsorbent column using polymyxin B-immobilized fiber in patients with gram-negative septic shock. Ther Apher. 2001;5:25-30 pubmed
    It has been reported that direct hemoperfusion with the adsorbent column using polymyxin B-immobilized fiber (DHP with PMX-F column) ameliorates hyperdynamic circulation in septic shock and improves survival rate...
  11. Ono S, Tsujimoto H, Matsumoto A, Ikuta S, Kinoshita M, Mochizuki H. Modulation of human leukocyte antigen-DR on monocytes and CD16 on granulocytes in patients with septic shock using hemoperfusion with polymyxin B-immobilized fiber. Am J Surg. 2004;188:150-6 pubmed
    b>Hemoperfusion with PMX-F (polymyxin B covalently immobilized on fibers) has been reported to be safe and effective for patients with septic shock. However, the molecular mechanism of this usefulness is not yet clear...
  12. Novelli G, Ferretti G, Ruberto F, Morabito V, Pugliese F. Early management of endotoxemia using the endotoxin activity assay and polymyxin B-based hemoperfusion. Contrib Nephrol. 2010;167:91-101 pubmed publisher
    We evaluated the ability of the endotoxin activity (EA) assay to determine the need for early intervention for endotoxemia using polymyxin B-based hemoperfusion (PMX-DHP) on septic patients.
  13. Baumer W, Mertens A, Braun M, Kietzmann M. The isolated perfused bovine uterus as a model for mucous membrane irritation and inflammation. ALTEX. 2002;19:57-63 pubmed
    ..In conclusion, the isolated perfused bovine uterus seems to be a promising in vitro model for mucous membrane irritancy as well as for inflammatory reactions. ..
  14. Kushi H, Miki T, Nakahara J, Okamoto K, Saito T, Tanjoh K. Hemoperfusion with an immobilized polymyxin B column reduces the blood level of neutrophil elastase. Blood Purif. 2006;24:212-7 pubmed
    We investigated whether direct hemoperfusion with an immobilized polymyxin B column (DHP with PMX) could reduce the blood level of neutrophil elastase. 20 sepsis patients were enrolled in the study...
  15. Sato N, Kojima K, Horio Y, Goto E, Masunaga A, Ichiyasu H, et al. Successful treatment of severe amiodarone pulmonary toxicity with polymyxin B-immobilized fiber column direct hemoperfusion. Chest. 2013;143:1146-1150 pubmed publisher
    ..Polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) is a medical device that reduces blood endotoxin levels in sepsis...
  16. Tojimbara T, Sato S, Nakajima I, Fuchinoue S, Akiba T, Teraoka S. Polymyxin B-immobilized fiber hemoperfusion after emergency surgery in patients with chronic renal failure. Ther Apher Dial. 2004;8:286-92 pubmed
    The purpose of this study was to evaluate the effect of direct hemoperfusion using a Polymyxin B (PMX) immobilized fiber column in septic patients with chronic renal failure after emergency surgery...
  17. Tsushima K, Kubo K, Koizumi T, Yamamoto H, Fujimoto K, Hora K, et al. Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome. J Clin Apher. 2002;17:97-102 pubmed
    ..We have studied whether direct hemoperfusion using a polymyxin B immobilized fiber column (PMX-DHP) is effective for acute lung injury (ALI) and ARDS...
  18. Hong S, Yang J, Lee E, Kim S. Effect of haemoperfusion on plasma paraquat concentration in vitro and in vivo. Toxicol Ind Health. 2003;19:17-23 pubmed
    ..3+/-19.9 versus 67.2+/-19.2%, P <0.01), we concluded that adequate HP appears to be an indispensable treatment for patients with acute PQ poisoning. ..
  19. Kushi H, Nakahara J, Miki T, Okamoto K, Saito T, Tanjo K. Hemoperfusion with an immobilized polymyxin B fiber column inhibits activation of vascular endothelial cells. Ther Apher Dial. 2005;9:303-7 pubmed
    ..We therefore investigated whether direct hemoperfusion (DHP) with a polymyxin B immobilized fiber column (PMX) could reduce the level of plasminogen activator ..
  20. Sato T, Shoji H, Koga N. Endotoxin adsorption by polymyxin B immobilized fiber column in patients with systemic inflammatory response syndrome: the Japanese experience. Ther Apher Dial. 2003;7:252-8 pubmed
    ..Further studies are needed to clarify the mechanisms of PMX treatment and to strengthen the scientific basis of this treatment. ..
  21. Ronco C. The place of early haemoperfusion with polymyxin B fibre column in the treatment of sepsis. Crit Care. 2005;9:631-3 pubmed
    ..This commentary considers whether the available evidence allows us to establish an appropriate role for PMX-F treatment in sepsis and what further work is needed. ..
  22. Nemoto H, Nakamoto H, Okada H, Sugahara S, Moriwaki K, Arai M, et al. Newly developed immobilized polymyxin B fibers improve the survival of patients with sepsis. Blood Purif. 2001;19:361-8; discussion 368-9 pubmed
    ..However, in severe sepsis, this therapy does not improve the survival rate. ..
  23. Cruz D, Perazella M, Bellomo R, De Cal M, Polanco N, Corradi V, et al. Effectiveness of polymyxin B-immobilized fiber column in sepsis: a systematic review. Crit Care. 2007;11:R47 pubmed
    ..We performed a systematic review to describe the effect in septic patients of direct hemoperfusion with PMX-F on outcomes of blood pressure, use of vasoactive drugs, oxygenation, and mortality reported in ..
  24. Tsujimoto H, Ono S, Hiraki S, Majima T, Kawarabayashi N, Sugasawa H, et al. Hemoperfusion with polymyxin B-immobilized fibers reduced the number of CD16+ CD14+ monocytes in patients with septic shock. J Endotoxin Res. 2004;10:229-37 pubmed
    CD16+ CD14+ monocytes dramatically increase in number in patients with severe infection. Hemoperfusion with PMX-F (direct hemoperfusion with polymyxin B immobilized fibers) has been reported to be a safe and effective treatment for ..
  25. Yamamoto T, Ono T, Ito T, Yamanoi A, Maruyama I, Tanaka T. Hemoperfusion with a high-mobility group box 1 adsorption column can prevent the occurrence of hepatic ischemia-reperfusion injury in rats. Crit Care Med. 2010;38:879-85 pubmed publisher
    ..b>Hemoperfusion therapy using a cellulofine sulfate bead column (high-mobility group box 1 adsorption column) was performed ..
  26. Kellum J, Uchino S. International differences in the treatment of sepsis: are they justified?. JAMA. 2009;301:2496-7 pubmed publisher
  27. Yantasee W, Fryxell G, Porter G, Pattamakomsan K, Sukwarotwat V, Chouyyok W, et al. Novel sorbents for removal of gadolinium-based contrast agents in sorbent dialysis and hemoperfusion: preventive approaches to nephrogenic systemic fibrosis. Nanomedicine. 2010;6:1-8 pubmed publisher
    ..those of activated carbon and zirconium phosphate currently used in the state-of-the-art sorbent dialysis and hemoperfusion systems...
  28. Nakamura T, Sugaya T, Koide H. Urinary liver-type fatty acid-binding protein in septic shock: effect of polymyxin B-immobilized fiber hemoperfusion. Shock. 2009;31:454-9 pubmed publisher
    ..in patients with septic shock or severe sepsis without shock and whether polymyxin B-immobilized fiber (PMX-F) hemoperfusion affects these levels...
  29. Murakami M, Miyauchi Y, Nishida M, Okada H, Hamano K. Direct hemoperfusion using polymyxin-B immobilized fiber for septic shock after cardiac surgery. Circ J. 2009;73:658-61 pubmed
    The factors contributing to the efficacy and outcome of direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP) after cardiac surgery were investigated...
  30. Schmidt D, Neale J, Olson K. Clinical course of a fatal ingestion of diquat. J Toxicol Clin Toxicol. 1999;37:881-4 pubmed
    ..We describe multiple metabolic abnormalities, an apparent artifact introduced by diquat in the laboratory assay for serum creatinine, serum diquat levels, and the need for emergency airway management. ..
  31. Kumagai T, Takeyama N, Yabuki T, Harada M, Miki Y, Kanou H, et al. Apheresis of activated leukocytes with an immobilized polymyxin B filter in patients with septic shock. Shock. 2010;34:461-6 pubmed publisher
    In this study, we examined the effects of direct hemoperfusion through filters with immobilized polymyxin B (PMX-DHP) on leukocyte function and plasma levels of cytokines in patients with septic shock...
  32. Wood S. Use of charcoal hemoperfusion. Crit Care Nurse. 2002;22:18, 20; author reply 20 pubmed
  33. Estrera A, Rubenstein F, Miller C, Huynh T, Letsou G, Safi H. Descending thoracic aortic aneurysm: surgical approach and treatment using the adjuncts cerebrospinal fluid drainage and distal aortic perfusion. Ann Thorac Surg. 2001;72:481-6 pubmed
  34. Shalkham A, Kirrane B, Hoffman R, Goldfarb D, Nelson L. The availability and use of charcoal hemoperfusion in the treatment of poisoned patients. Am J Kidney Dis. 2006;48:239-41 pubmed
    Charcoal hemoperfusion (CHP) has been one of the preferred methods to enhance the elimination of certain toxins in selected poisoned patients...
  35. Erguven M, Yilmaz O, Deveci M, Aksu N, Dursun F, Pelit M, et al. Mushroom poisoning. Indian J Pediatr. 2007;74:847-52 pubmed
    ..We aimed to review characteristics of mushrooms and mushroom poisoning and compare clinical picture, laboratory data, treatment modalities and prognostic factors in children with amanita intoxication and non-amanita mushroom poisoning...
  36. Thanacoody R. Extracorporeal elimination in acute valproic acid poisoning. Clin Toxicol (Phila). 2009;47:609-16 pubmed publisher
    ..b>Hemoperfusion also enhances VPA elimination, but its effectiveness may be limited by column saturation...
  37. Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda K, Nakamura M, et al. Cytokine adsorptive property of various adsorbents in immunoadsorption columns and a newly developed adsorbent: an in vitro study. Blood Purif. 2004;22:530-6 pubmed
    ..Selective cytokine adsorption columns could be developed with improvement of currently available adsorbents. Such a new selective cytokine adsorption column could be clinically applied for the treatment of SIRS/sepsis. ..
  38. Chang T. Artificial cells containing detoxicants. 1972 [classical article]. Artif Cells Blood Substit Immobil Biotechnol. 2002;30:457-68 pubmed
  39. Kanno Y, Suzuki H. Selection of modality in continuous renal replacement therapy. Contrib Nephrol. 2010;166:167-72 pubmed publisher
    Continuous hemoperfusion therapies are now widely used in critical care, and could prove to be life-saving for patients unable to receive regular hemoperfusion treatments...
  40. Lai D, Wang J, Yao J, Wang Y, Cheng G. [The assessment of hemoperfusion for the treatment of acute methamidophos poisoning]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2011;29:440-2 pubmed
    To explore the effect of hemoperfusion(HP) about the patients of methamidophos poisoning...
  41. Naruse K, Sakai Y, Natori T, Guo L, Shindoh J, Iida Y, et al. Xenogeneic direct hemoperfusion using whole swine liver for liver failure in dogs. J Surg Res. 2003;111:229-35 pubmed
    We developed a new method of xenogeneic direct hemoperfusion of a bioartificial liver support system consisting of a leukocyte-adsorbent column, an immunoglobulin-adsorbent column, and the substitute unit for hepatic function...
  42. Kanesaka S, Sasaki J, Kuzume M, Narihara K, Takahashi Y. Effect of direct hemoperfusion using polymyxin B immobilized fiber on inflammatory mediators in patients with severe sepsis and septic shock. Int J Artif Organs. 2008;31:891-7 pubmed
    The objective of this study was to investigate retrospectively the effect of direct hemoperfusion using polymyxin B immobilized fiber (PMX-DHP) in a cartridge to remove endotoxin on inflammatory mediators in septic patients...
  43. Shimizu T, Hanasawa K, Sato K, Umeki M, Koga N, Naganuma T, et al. Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation. Langenbecks Arch Surg. 2009;394:303-11 pubmed publisher
    Although some studies have reported favorable effects of direct hemoperfusion with polymyxin-B-immobilized fiber columns (PMX) for the treatment of septic shock, few studies have demonstrated the efficacy of PMX in studies with a uniform ..
  44. Jung J, Eo E, Ahn K. A case of hemoperfusion and L-carnitine management in valproic acid overdose. Am J Emerg Med. 2008;26:388.e3-4 pubmed publisher
    ..We report a patient with VPA overdose who was treated successfully with hemoperfusion with activated charcoal and L-carnitine...
  45. Gao Y, Chen Y, Deng H, Zhong F, Li Y. [Evaluation of charcoal hemoperfusion in dogs with acute fluoroacetamide poisoning]. Zhonghua Er Ke Za Zhi. 2007;45:661-4 pubmed
    ..During the recent ten years the authors treated children with severe FAM poisoning with charcoal hemoperfusion (HP) and achieved better results...
  46. Sakka S, Kuethe F, Demme U, Huttemann E. [Intoxication with a tricyclic antidepressant]. Anaesthesist. 2007;56:581-6 pubmed
    ..No life-threatening arrhythmia occurred at any time. On the advice of the poison information center, hemoperfusion was performed for extracorporeal elimination...
  47. Naruse K, Makuuchi M. Development and perspectives of bioartificial liver support. Hepatogastroenterology. 2002;49:91-5 pubmed
    ..We developed a new system of xenogeneic direct hemoperfusion consisting of a leukocyte adsorbent, an immunoglobulin adsorbent, and a substitute unit for hepatic function, ..
  48. Cao N, Yu Y, Wang M, Chen C. In vitro study of a novel low-density lipoprotein adsorbent. Artif Cells Blood Substit Immobil Biotechnol. 2002;30:53-61 pubmed
  49. Meyer S, Kuhlmann M, Peters F, Limbach H, Lindinger A. Severe valproic acid intoxication is associated with atrial tachycardia: secondary detoxication by hemoperfusion. Klin Padiatr. 2005;217:82-5 pubmed
    ..Secondary detoxication by hemodialysis or hemoperfusion has been employed successfully in valproic acid intoxication...
  50. Macia M, Avilés J, Navarro J, Morales S, Garcia J. Efficacy of molecular adsorbent recirculating system for the treatment of intractable pruritus in cholestasis. Am J Med. 2003;114:62-4 pubmed
  51. Hou G, Liu T, Wang H, Fu G, Yuan Z, Liu B, et al. Preparation of adsorbents for the removal of endotoxin. Artif Cells Blood Substit Immobil Biotechnol. 2005;33:227-37 pubmed
    ..ligand and hexamethylendiamine as the spacer, was the best in adsorption capacity and was selected for hemoperfusion on rabbits...
  52. Ushida H, Koizumi S, Johnin K, Katoh K, Okada Y. [Experience of direct hemoperfusion using polymyxin B-immobilized fiber on patients with endotoxin shock from urosepsis]. Hinyokika Kiyo. 2001;47:329-31 pubmed
    We report the effects of direct hemoperfusion using polymyxin B-immobilized fiber (PMX treatment) on two patients with endotoxin shock from urosepsis...
  53. Park S, Lee S, Park S, Gil H, Lee E, Yang J, et al. Concurrent Hemoperfusion and Hemodialysis in Patients with Acute Pesticide Intoxication. Blood Purif. 2016;42:329-336 pubmed
    ..chemicals in the pesticide formulation may be eliminated more effectively in time if hemodialysis (HD) and hemoperfusion (HP) are performed concurrently...