Clearance effects of blood purification on chlorfenapyr and tralopyril in chlorfenapyr poisoning patients

BACKGROUND: This study is to evaluate clearance eff ects of hemoperfusion (HP), continuous renal replacement therapy (CRRT), and plasma exchange (PE) for chlorfenapyr and its metabolite tralopyril in patients with acute poisoning.METHODS: This retrospective study included 18 patients with acute oral chlorfenapyr poisoning treated at our department between January 2022 and January 2024.All patients received conventional therapies combined with blood purification, including HP, CRRT, and PE.HP was performed three sessions within the fi rst 24 h, followed by CRRT and PE.Serial blood samples were collected to measure plasma concentrations of chlorfenapyr and tralopyril using gas chromatography/ liquid chromatography-mass spectrometry (GC/LC-MS).The toxin-clearance eff ects were assessed using a linear mixed-eff ects (LME) model. RESULTS:The hourly decline rate of the plasma chlorfenapyr concentration (median [IQR]) was 8.83% (1.79%) for HP, 4.12% (1.26%) for CRRT, and 6.85% (1.44%) for PE.LME analysis showed higher decline rate in the plasma concentration with HP (β=5.00;P