Advancing evidence in extracorporeal poison removal

A prospective international multicentre registry collecting real-world data on extracorporeal detoxification treatments in severe poisoning providing the evidence base to improve clinical decision-making worldwide.

What is IRED?

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International

Multicentre registry across hospitals worldwide

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Toxicology

Severe poisoning treated with extracorporeal techniques

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Real-world data

Standardised prospective data collection

Calculate SILENT riskPredict the risk of developing SILENT in patients with lithium poisoning.

About

Why IRED?

RRT is a fundamental intervention in toxicology when life-threatening substances can be removed extracorporeally. Common indications include severe poisoning with lithium, metformin, salicylates, and toxic alcohols, particularly when conventional therapies are insufficient or end-organ damage is present.

EXTRIP workgroup recommendations represent the most comprehensive guidance available, but most are based on very low quality evidence. The landscape is also shifting with new antidotes: fomepizole for methanol and ethylene glycol, and glucarpidase for methotrexate toxicity.

Why IRED?The International Registry of Extracorporeal Detoxification (IRED) was born as a collaborative response to the need for evidence. Given the scarcity of robust data, this registry has been established to collect and analyse global clinical experience. IRED seeks to transform clinical practice by providing evidence to strengthen future recommendations and improve outcomes worldwide.

Objectives

What we aim to achieve

Primary Objective

To evaluate adherence to EXTRIP recommendations regarding the use of renal replacement therapies in the management of severe poisoning by lithium, metformin, salicylates, methanol, and ethylene glycol in tertiary care hospitals.

To determine the effectiveness of RRT in reducing morbidity and mortality.

To identify predictors of poor outcomes — mortality, length of stay, organ dysfunction, and irreversible sequelae.

To describe the incidence of toxin-specific complications for each poisoning.

To assess the safety of RRT and potential adverse events in this context.

Toxins Under Study

Lithium

SILENT syndrome

MeOH

Methanol

Persistent visual impairment and blindness

Ethylene glycol

Chronic kidney disease

Salicylates

Respiratory and metabolic complications

Metformin

Lactic acidosis

Participants

Active Members

IRED is comprised of international participants from various fields — clinical pharmacology, nephrology, internal medicine, medical toxicology, emergency medicine, and critical care — with expertise in severe poisoning and extracorporeal detoxification treatments.

BRA

Belén Ruiz-Antorán, MD, PhD

Toxicology / Pharmacology, Chair

Spain

ACB

Antonio F. Caballero Bermejo, MD, PhD

Toxicology / Pharmacology, Co-chair

Spain

Data & Registry

How to participate

Contact the coordinating centre

Send an expression of interest to the steering committee at Hospital Universitario Puerta de Hierro, Madrid.

Sign the site agreement

Complete the site agreement and obtain local ethics committee approval for your institution.

Access REDCap eCRF

Receive login credentials for the centralised REDCap database. Data entered via eCRF including clinical features, treatments, RRT use, outcomes and safety.

Start recruiting

Include all eligible patients with poisoning due to lithium, metformin, salicylates, methanol, or ethylene glycol, retrospectively since 2012 and prospectively.

📌 Each participating centre has access to its own data at all times through REDCap. Access to aggregated data is available upon request and subject to steering committee approval.

Publications

Publications & presentations

IRED is a new registry — publications are forthcoming.

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Peer-reviewed articles

Original research papers published in indexed journals.

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Conference abstracts

Abstracts at EAPCCT, ACMT, ESN, and other meetings.

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Presentations

Oral and poster presentations at congresses.

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Registry reports

Annual reports on activity and key findings.

📌 First publications expected once the registry reaches sufficient sample size.

SILENT-60 Risk Calculator

Screening tool for Irreversible Lithium-Effectuated Neurotoxicity at 60 days

Developed by Antonio F. Caballero Bermejo and Belén Ruiz Antorán on behalf of the SILITOX investigators.

Patient Parameters

Age (years)

Peak urea (mg/dL)

Ataxia (during acute episode)

Myoclonic jerks (during acute episode)

PSS ≥ 2 (moderate-to-severe)

Poisoning type

Screening-positive by the calculator?

Screening-positive defined as predicted probability ≥ 0.0475

YES

Prioritize neurological follow-up

Planned post-discharge review
Neurological assessment
Consider EEG/MRI if clinically indicated*
Review lithium therapy and risk mitigation

Standard care

Routine post-discharge care (per local practice)
Safety-net advice at discharge
Reassessment if persistent/new neurological symptoms

* Ancillary tests (e.g., EEG and MRI) may be considered based on clinical judgement in patients with persistent or evolving symptoms.

News & Events

Stay updated with the latest developments, upcoming events, and milestones from the IRED registry.

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No news or events published yet. This section will be updated as the registry progresses.

Contact

We welcome collaboration from hospitals and research groups interested in joining the registry.

Open to hospitals, toxicology units, nephrology and ICU teams, and research networks worldwide.