Therapeutic Apheresis and Dialysis最新文献

Introduction: We aimed to investigate the relationship between monocyte/lymphocyte ratio (MLR) and monocyte/high-density lipoprotein ratio (MHR) with abdominal aortic calcification (AAC) in patients on peritoneal dialysis (PD).

Methods: The time-averaged (TA) of relevant indexes and AAC scores (AACs) of 160 eligible patients were measured.

Results: Patients divided into the new AAC (n = 57) and the other without (n = 82). High TA-MLR (OR = 110.537, p = 0.018) and long duration of dialysis (OR = 1.045, p < 0.001) were independent risk factors of the new AAC. Patients divided into the no AAC (n = 82), the moderate-to-severe AAC (n = 26), and the mild AAC (n = 52). High TA-MLR (OR = 42.649, p = 0.032), high age at starting PD (OR = 1.055, p < 0.001), and long duration of PD (OR = 1.036, p < 0.001) were independent risk factors of AAC severity.

Conclusions: MLR is an independent risk factor for the occurrence and severity of AAC and its value for the assessment of AAC is better than MHR.

Background and objectives: The coagulation cascade is activated during hemodialysis (HD) due to interaction of blood with the dialysis circuit. There is a paucity of data on the effect of the physical structure of the dialyzers on coagulation activation during HD. We conducted this study to compare the effect of Helixone FX80 versus Platinum H4 dialyzers on coagulation activation during HD.

Methods: Twenty patients on maintenance HD were enrolled in this randomized prospective crossover study. Each patient was dialyzed using Helixone FX80 and Platinum H4 dialyzers. Serum thrombin-antithrombin complex (TAT) was measured before (T0h) and at the end (T4H) of HD.

Results: The absolute changes of serum TAT were comparable with the two dialyzers (median [IQR]: 1.15 [0.65, 1.75] for Helixone FX80 vs. 1.15 [0.67, 2.05] for Platinum H4, p = 0.371).

Conclusion: Helixone FX80 and Platinum H4 dialyzers have similar effects on coagulation activation during HD.

Introduction: Cancer and hemodialysis (HD) patients are at high risk for COVID-19. In our study, we aimed to evaluate the effect of pandemic on anxiety in these patients.

Methods: One hundred and six oncology and 97 HD patients participated in the study. Anxiety levels were assessed by using the Beck Anxiety Inventory (BAI) and State-Trait Anxiety Inventory (STAI). At the end of 8-month follow-up, these questionnaires were re-administered.

Results: During this period, 38 patients (38/203; 18.7%) had COVID-19 infection. Twenty-three patients (23/203; 11.3%) died due to COVID-19 and/or other causes. One hundred and thirteen of the remaining patients were participated in the second questionnaire. Having COVID-19 was not the independent factor for changes in STAI, and BAI scores in any regression models.

Conclusion: Having COVID-19 does not affect the increased anxiety levels in HD and oncology patients. The effect of the pandemic may have remained in the background, as these patients have more concerns about their own diseases.

Introduction: We performed a meta-analysis to evaluate the effect of the nonpharmacologic interventions on muscle related symptoms including cramping and restless leg syndrome in hemodialysis patients.

Methods: Articles published between 2002 and 2022 were searched in six databases. The standardized mean differences were determined by the upper and lower limits of 95% confidence intervals. Publication bias was assessed by conducting the Egger test and examined visually using a funnel plot.

Results: Fourteen studies were included in this meta-analysis. The types of interventions included exercise (n = 5), aromatherapy (n = 5), reflexology (n = 3), massage (n = 1), and acupressure (n = 1). The methodological quality assessment revealed 13 studies were strong quality, while only one study was moderate quality. The Egger test indicated no significant publication biases.

Conclusion: Healthcare professionals can use non-pharmacological methods to manage muscle-related symptoms because of not only beneficial effects but also it is practical, well-tolerated, easy integrated into the treatment and care.

Introduction: Inadequate dialysis and fluid overload are corrected after starting combined therapy with peritoneal dialysis (PD) and hemodialysis (HD). However, the effects on anemia management has not been elucidated.

Methods: We conducted a prospective, multicenter, observational cohort study of 40 PD patients (age, 60 ± 10 years; male, 88%; median PD duration, 28 months) starting combined therapy and investigated changes in several clinical parameters, including erythropoiesis-stimulating agent (ESA) resistance index (ERI).

Results: ERI decreased significantly during 6 months after switching to combined therapy (from 11.8 [IQR 8.0-20.4] units/week/kg/(g/dL) to 7.8 [IQR 3.9-18.6] units/week/kg/(g/dL), p = 0.047). Body weight, urinary volume, serum creatinine and the dialysate-to-plasma creatinine ratio (D/P Cr) decreased, whereas hemoglobin and serum albumin increased. In subgroup analysis, the changes in ERI were not affected by cause for starting combined therapy, PD holiday and D/P Cr.

Conclusion: Although detailed mechanism was unclear, ESA responsiveness improved after switching from PD alone to combined therapy.

Introduction: The clinical benefit of vitamin D receptor activators (VDRA) in patients with well-controlled secondary hyperparathyroidism undergoing dialysis remains unclear.

Methods: This post hoc analysis of the LANDMARK study investigates if VDRA use is associated with cardiovascular benefits. Data of 2135 patients undergoing hemodialysis who were at risk for vascular calcification were analyzed using a Cox proportional hazards model with propensity-score matching.

Results: The hazard ratio (HR) for VDRA use was 0.99 (95% confidence interval [CI]: 0.67-1.46; p = 0.945) for cardiovascular events and 0.89 (95% CI: 0.62-1.28; p = 0.541) for all-cause mortality at baseline. Among patients who always used VDRA, the HR was 1.12 (95% CI: 0.67-1.89; p = 0.666) for cardiovascular events and 1.11 (95% CI: 0.67-1.85; p = 0.688) for all-cause mortality compared to those who never used VDRA.

Conclusion: The use of VDRA does not reduce the risks of cardiovascular events or all-cause mortality in patients on dialysis with well-controlled secondary hyperparathyroidism.