Therapeutic Apheresis and Dialysis最新文献

Introduction: The aim of this study was to analyze the efficiency of CytoSorb adsorber in patients presenting with cardiogenic shock and treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Methods: Sixteen patients put on VA ECMO due to cardiogenic shock were included, stratified according to the use of Cytosorb adsorber in the first 24 h and compared across different clinical outcomes.

Results: Significantly lower vasopressor doses were required among patients treated with Cytosorb at the initiation and before weaning from ECMO. Furthermore, these patients showed significantly higher urine output before weaning and lower lactate levels during the extracorporeal support. Finally, the mortality rate was lower among the Cytosorb therapy group (22.2% vs 57.1%).

Conclusion: While a decrease in vasopressor doses was already associated with CytoSorb use, this is the first study showing an increase in urinary output and a trend towards better survival among patients on VA ECMO treated with CytoSorb.

Introduction: Chronic systemic inflammation was proposed as a critical factor in the development of osteoporosis. We aim to investigate the effect of the DII on bone mineral density (BMD) in CKD patients.

Methods: 2276 participants from NHANES were enrolled. The DII score was calculated based on a single 24-h dietary recall. Total BMD was measured using Dual-energy x-ray absorptiometry. A multiple-stepwise linear regression model was used to determine associations between BMD and DII in CKD patients.

Results: When DII >0.35, a negative correlation was obtained between DII and BMD (all β = -0.008 and p < 0.05). In subgroup analysis, BMD levels decreased across increasing tertiles of the DII for patients with non-osteoporosis, postmenopause, and low eGFR (p for trend ≤0.01).

Conclusion: Higher consumption of pro-inflammatory diet correlates negatively with the BMD levels in CKD patients.

Introduction: This study elucidates factors affecting the severity and mortality in pre-Omicron and Omicron strains of SARS-CoV-2 and vaccination impact.

Methods: This single-center retrospective observational study included 1598 hospitalized COVID-19 patients. Patients were grouped into "pre-Omicron" and "Omicron" periods. The endpoint was severe COVID-19 (oxygen saturation [SpO₂ ] < 94%). Logistic regression examined associations between clinical factors, including hemodialysis (HD), and the endpoint.

Results: The HD patient mortality rate dropped from 16% pre-Omicron to 4% during the Omicron epidemic. HD was significantly associated with the study endpoint in both epidemics. Unvaccinated patients had a greater risk of reaching the study endpoint among patients receiving HD.

Conclusion: These findings suggest that the Omicron variant, alongside vaccination and healthcare innovations, led to improved prognoses for HD patients with COVID-19. However, HD patients remain at a greater risk for severe COVID-19. Increased vaccination rates and optimized healthcare resources can improve this vulnerable population's prognoses.

Background and aim: Daugirdas suggested a 2-pool phosphate kinetic model based on his previously established urea kinetic model. The current study aims to assess the level of agreement between the modeled daily ingested phosphorus (DIP) values and the routine method of dietary recall calculations in hemodialysis patients.

Method: The study was conducted on 100 hemodialysis patients; 50 were anuric, and the others had residual kidney function (RKF). The level of correlation and agreement between the dietary calculated and modeled DIP were assessed in both study groups.

Results: A statistically significant positive correlation existed between the calculated and modeled DIP (r = 0.79 for the anuric group, r = 0.84 for the RKF group, p < 0.001). There was a significant level of agreement between calculated and modeled DIP in RKF patients only.

Conclusion: These findings suggest that phosphate modeling can estimate phosphate intake in RKF patients and be cost-effective in their management.

Introduction: Plasma exchange (PE) is widely used in many immune-based neurological diseases. Our aim is to analyze characteristics of PE in neurological patients at the Clinical Center of Montenegro.

Methods: Our study involved neurological patients treated with PE between January 2020 and April 2022.

Results: In total, 246 PEs were performed in 43 patients. We divided patients into 4 groups according to indications. In 8/9 multiple sclerosis (MS) patients a decrease of Expanded Dysability Status Scale at least 0.5 was verified. In 14/20 Guillain Barre syndrome patients reduction of Hughes was observed. Four patients with myasthenia gravis (MG) were treated with PE. The most heterogeneous group (4) consisted of patients in whom the mechanism of disease development is assumed to be immune system dysregulation. Fourteen patients had any adverse event.

Conclusion: Our results show that PE is widely used and safe in the treatment of neurological diseases.

Introduction: This retrospective study examined the relationship between the Glasgow Prognostic Score (GPS) at hemodialysis (HD) initiation and overall/cardiovascular mortality.

Methods: A total of 264 patients starting HD between 2014 and 2015 at a single center were studied. Follow-up persisted until therapy change, death, or study end (December 31, 2021), with a median of 6.8 years.

Results: Patients with a higher GPS more frequently had emergent HD initiation and showed increased eGFR at initiation. During follow-up, 60% of patients died, with cardiovascular disease being the leading cause. Univariate analysis revealed a significant difference in median survival time across GPS classes. Cox proportional hazard models confirmed a significant association between GPS and mortality.

Conclusions: We report a significant association between GPS at HD initiation and mortality. GPS may prove useful as a prognostic tool for identifying high-risk patients, underscoring the need for future research to validate these findings and explore the potential of GPS-based interventions.

Introduction: Acute disseminated encephalomyelitis is a rare acute demyelinating disease of the central nervous system (CNS). The pathogenesis remains unclear but is suspected to be autoimmune. High doses of methylprednisolone (HDMP) are currently considered standard of treatment. Plasmapheresis (PE) is typically given in steroid refractory cases. There is currently limited evidence supporting its use in ADEM.

Materials and methods: We report a 16-year-old girl with ADEM who improved rapidly after initiating PE.

Results: The patient presented with acute onset of multifocal CNS symptoms, including encephalopathy, requiring intensive care unit management. Despite HDMP administration, her clinical condition continued to deteriorate. PE was therefore initiated on the same day as HDMP. Her clinical condition improved significantly following the first session. She was extubated and discharged from the intensive care unit the following day.

Conclusion: HDMP combined with PE may be an effective first-line treatment in patients with fulminant ADEM.

Objective: The present study was designed to explore the association between serum sodium and mortality in patients with sepsis by using a large sample, multicenter MIMIC-IV database.

Methods: We extracted the data of 34 925 sepsis patients from the retrospective cohort mimicIV database. After adjusting the confounders, we explored the independent effects of serum sodium on 28-day mortality.

Results: A nonlinear relationship existed between serum sodium and 28-day mortality, of which a negative association was found between serum sodium and 28-day mortality (odds ratio: 0.95, 95% CI: 0.94, 0.96, p = 0.0001) when serum sodium was in 102 mmol/L to 138 mmol/L, but a positive correlation appeared when sodium climbed to the range of 140-179 mmol/L (odds ratio: 1.04, 95% CI: 1.03-1.06, p = 0.0001).

Conclusions: Both lower and higher serum sodium levels are associated with an increased risk of death in sepsis patients.