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IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 DOI: 10.1111/1744-9987.13880

Asahi Kasei Medical Co., Ltd. (Tokyo, Japan) is a world leader in research, development, and production of devices and systems for blood treatment and purification based on advanced membrane separation and adsorption technologies. It serves the global market with dialysis products and therapeutic apheresis devices, such as membrane type plasma separators, plasma component separators, and immunoadsorption columns. Asahi Kasei Medical’s core competence is in blood related polymer technologies, materials technologies, and blood analysis technologies. The Research and Development Division is developing next-generation products based in these technologies for fields ranging from extracorporeal therapy to organ function diagnosis and artificial organs. Now, as always, Asahi Kasei Medical is dedicated to serving and advancing medical therapy for the preservation and enhancement of human life. Website: http://www.asahikasei-medical.com

引用次数: 0

Inclisiran and lipoprotein apheresis in statin intolerance heterozygous FH patients: A case series. 他汀类药物不耐受杂合子FH患者的Incisiran和脂蛋白单采：一个病例系列。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 Epub Date: 2023-06-14 DOI: 10.1111/1744-9987.14025

Beatrice Dal Pino, Federico Bigazzi, Francesco Sbrana

Dear Editor, In Familial Hypercholesterolemia (FH), statins treatment is the first choice to lower LDL cholesterol and to reduce cardiovascular morbidity and mortality, however, up to 10% of patients treated with statins report intolerance [1]. Monoclonal antibodies against Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (mAb PCSK9i) could be administered to lower LDL cholesterol in patients with muscle-related adverse events, but intolerance to mAb PCSK9i has also been described [2]. Within this context, Lipoprotein Apheresis (LA) still holds a valuable role, even in the new era of Lipid-Lowering Therapy (LLT) [2]. Inclisiran is a novel small interfering RNA-based drug (siRNA) anti-PCSK9 play a role in patients when optimal LDL-C cannot be achieved by statins and/or mAb PCSK9i [3]. We enrolled 5 patients in chronic LA (mean age 64 ± 8 years, female 60%) affected by heterozygous FH and AtheroSclerotic CardioVascular Disease (ASCVD), with history of statin intolerance and mAb PCSK9i adverse events (flue like syndrome in 3/5 patients, severe CPK increase in 1/5 patient and low therapeutic compliance in 1/5 patient). These patients, after the discontinuation of mAb PCSK9i, were assigned to inclisiran therapy (dosing schedule: 284 mg s.c. injection of at 0–90–180 days and every 6 months thereafter) and followed up for 3 months. The LA treatment was performed at bi-weekly interval by dextran-sulfate (Liposorber-LA systems; Kaneka, Osaka, Japan; 3/5 patients) or heparin-induced LDL precipitation apheresis (HELP, Plasmat Futura; B. Braun, Melsungen, Germany; 2/5 patients). After 3 months of therapy, a significant decrease in total cholesterol ( 19%), LDL cholesterol ( 27%), Apo B lipoprotein ( 24%) and triglycerides ( 13%) levels was observed without significant modification in other parameters (see Table S1). During the study period, the clinical response between inclisiran and mAb PCSK9i showed no difference (see Figure 1). One patient who achieved the recommended therapeutic target for LDL cholesterol and Lp(a) levels (respectively below 55 and 60 mg/dL, as indicated by international guidelines) discontinued LA. Adverse events were reported in 2/5 (40%) of patients: one referred transient episodes of mild difficulty to maintain concentration after 2 weeks of drug administration, another patient presented a cutaneous herpes zoster infection. No injection-site reaction was reported. In contrast to mAb PCSK9i, inclisiran inactivates PCSK9 by inhibition of its hepatic synthesis. The safety, tolerability, and efficacy of inclisiran have been studied within the ORION clinical development program who demonstrated a sustained PCSK9 suppression of about 80% and time-adjusted LDL-C reduction of approximately 50% from baseline. Furthermore, the safety profile of inclisiran was found to be comparable to that of mAb PCSK9i and the most commonly reported adverse effect was a mild-to-moderate transient injection site reaction [3]. It provides a therapeutic

{"title":"Inclisiran and lipoprotein apheresis in statin intolerance heterozygous FH patients: A case series.","authors":"Beatrice Dal Pino, Federico Bigazzi, Francesco Sbrana","doi":"10.1111/1744-9987.14025","DOIUrl":"10.1111/1744-9987.14025","url":null,"abstract":"Dear Editor, In Familial Hypercholesterolemia (FH), statins treatment is the first choice to lower LDL cholesterol and to reduce cardiovascular morbidity and mortality, however, up to 10% of patients treated with statins report intolerance [1]. Monoclonal antibodies against Proprotein Convertase Subtilisin/Kexin type 9 inhibitors (mAb PCSK9i) could be administered to lower LDL cholesterol in patients with muscle-related adverse events, but intolerance to mAb PCSK9i has also been described [2]. Within this context, Lipoprotein Apheresis (LA) still holds a valuable role, even in the new era of Lipid-Lowering Therapy (LLT) [2]. Inclisiran is a novel small interfering RNA-based drug (siRNA) anti-PCSK9 play a role in patients when optimal LDL-C cannot be achieved by statins and/or mAb PCSK9i [3]. We enrolled 5 patients in chronic LA (mean age 64 ± 8 years, female 60%) affected by heterozygous FH and AtheroSclerotic CardioVascular Disease (ASCVD), with history of statin intolerance and mAb PCSK9i adverse events (flue like syndrome in 3/5 patients, severe CPK increase in 1/5 patient and low therapeutic compliance in 1/5 patient). These patients, after the discontinuation of mAb PCSK9i, were assigned to inclisiran therapy (dosing schedule: 284 mg s.c. injection of at 0–90–180 days and every 6 months thereafter) and followed up for 3 months. The LA treatment was performed at bi-weekly interval by dextran-sulfate (Liposorber-LA systems; Kaneka, Osaka, Japan; 3/5 patients) or heparin-induced LDL precipitation apheresis (HELP, Plasmat Futura; B. Braun, Melsungen, Germany; 2/5 patients). After 3 months of therapy, a significant decrease in total cholesterol ( 19%), LDL cholesterol ( 27%), Apo B lipoprotein ( 24%) and triglycerides ( 13%) levels was observed without significant modification in other parameters (see Table S1). During the study period, the clinical response between inclisiran and mAb PCSK9i showed no difference (see Figure 1). One patient who achieved the recommended therapeutic target for LDL cholesterol and Lp(a) levels (respectively below 55 and 60 mg/dL, as indicated by international guidelines) discontinued LA. Adverse events were reported in 2/5 (40%) of patients: one referred transient episodes of mild difficulty to maintain concentration after 2 weeks of drug administration, another patient presented a cutaneous herpes zoster infection. No injection-site reaction was reported. In contrast to mAb PCSK9i, inclisiran inactivates PCSK9 by inhibition of its hepatic synthesis. The safety, tolerability, and efficacy of inclisiran have been studied within the ORION clinical development program who demonstrated a sustained PCSK9 suppression of about 80% and time-adjusted LDL-C reduction of approximately 50% from baseline. Furthermore, the safety profile of inclisiran was found to be comparable to that of mAb PCSK9i and the most commonly reported adverse effect was a mild-to-moderate transient injection site reaction [3]. It provides a therapeutic","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 5","pages":"978-979"},"PeriodicalIF":1.9,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10502438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Influence of dialysis-related stigma on health-related indicators in Japanese patients undergoing hemodialysis. 透析相关污名对接受血液透析的日本患者健康相关指标的影响。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 Epub Date: 2023-04-13 DOI: 10.1111/1744-9987.13992

Hidehiro Sugisawa, Yumiko Shimizu, Tamaki Kumagai, Kanji Shishido, Yutaka Koda, Toshio Shinoda

Introduction: Focusing on impacts to health-related indicators in older Japanese patients, this study analyzed both the direct influence of dialysis-related stigma and influences of its intersectionality with other stigmatized characteristics.

Methods: Data were collected through a cross-sectional survey of 7461 outpatients in dialysis facilities. Other stigmatized characteristics include lower income, lower education, disabled activities of daily living, and diabetic end-stage renal disease (ESRD) as a cause for starting dialysis treatment.

Results: The average rate of an "agree" response on dialysis-related stigma items was 18.2%. Dialysis-related stigma significantly influenced all three health-related indicators, including suspected depression, informal networks, and compliance with dietary therapy. In addition, each interaction between dialysis-related stigma and educational attainment, gender, and diabetic ESRD significantly influence one health-related indicator.

Conclusion: These results suggest that dialysis-related stigma has both a significant direct and synergic influence with other stigmatized characteristics on health-related indicators.

引言：本研究以日本老年患者对健康相关指标的影响为重点，分析了透析相关污名化的直接影响及其与其他污名化特征的交叉性的影响。方法：通过对7461名透析门诊患者的横断面调查收集数据。其他被污名化的特征包括收入低、教育程度低、日常生活活动残疾，以及糖尿病终末期肾病（ESRD）是开始透析治疗的原因。结果：对透析相关污名项目的平均“同意”率为18.2%。透析相关污名化显著影响所有三个健康相关指标，包括疑似抑郁症、非正式网络和饮食治疗依从性。此外，透析相关污名与教育程度、性别和糖尿病终末期肾病之间的每一种相互作用都会显著影响一个健康相关指标。结论：这些结果表明，透析相关污名化与其他污名化特征对健康相关指标具有显著的直接和协同影响。

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引用次数: 1

Severe posthemodialysis thrombocytopenia: What if it's not the heparin? 严重的透析后血小板减少症：如果不是肝素怎么办？

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 Epub Date: 2023-04-18 DOI: 10.1111/1744-9987.13994

Leonidas Cruzado Vega, Juan P Moret Chiappe, Alba Santos García

We present the case of an 80-year-old man who received 4-h 3-weekly postdilution online hemodiafiltration (OL-HDF) with a polyethersulfone membrane. He achieved >30 L of convective transport/session and good dialysis adequacy.

引用次数: 0

Impact of therapeutic and low volume plasma exchange on clinical laboratory parameters in patients treated for Alzheimer's disease from the AMBAR study. AMBAR研究中治疗性和低容量血浆交换对阿尔茨海默病患者临床实验室参数的影响。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 Epub Date: 2023-05-21 DOI: 10.1111/1744-9987.14002

Carlota Grifols, Miquel Barceló, Laura Núñez, Zbigniew M Szczepiorkowski, Mercè Boada, Oscar L López, Antonio Páez

Introduction: Little is known about the impact of plasma exchange (PE) on clinical laboratory parameters in Alzheimer's disease (AD) patients.

Methods: AD patients in the AMBAR trial (N = 322) received weekly therapeutic PE (TPE) for 6 weeks followed by monthly low-volume PE (LVPE) for12 months. Treatment were placebo (sham PE), low-albumin, low-albumin + IVIG (i.e., albumin alternated with intravenous immunoglobulin) and high-albumin + IVIG.

Results: Coagulation parameters transiently increased post-TPE. Blood calcium, platelets, and albumin levels decreased but remained within the reference range. Leukocyte counts increased. Fibrinogen, hemoglobin, total protein, gamma globulin, and IgG, transiently dipped below the reference range. Hypogammaglobulinemia (7.2 g/L) persisted in pre-TPE measurements. No changes were observed during the LVPE period. Cerebrospinal fluid parameters and vital signs were unchanged throughout.

Conclusion: Laboratory parameters of AD patients were affected by TPE similarly to effects of PE-treatment for other pathologies. These effects were less pronounced or non-existent for LVPE.

引言：人们对血浆交换（PE）对阿尔茨海默病（AD）患者临床实验室参数的影响知之甚少。方法：在AMBAR试验中AD患者（N = 322）接受每周治疗性PE（TPE）6 周后每月低容量PE（LVPE）12 月。治疗为安慰剂（假PE）、低白蛋白、低白蛋白 + IVIG（即白蛋白与静脉注射免疫球蛋白交替）和高白蛋白 + IVIG。结果：TPE后凝血参数瞬时增加。血钙、血小板和白蛋白水平下降，但仍在参考范围内。白细胞计数增加。纤维蛋白原、血红蛋白、总蛋白、丙种球蛋白和IgG暂时低于参考范围。低丙种球蛋白血症（7.2 g/L）。LVPE期间未观察到任何变化。脑脊液参数和生命体征始终没有变化。结论：TPE对AD患者的实验室参数的影响与PE治疗其他疾病的影响相似。LVPE的这些影响不太明显或根本不存在。

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引用次数: 0

Trapped lung and refractory pleural effusion in a patient receiving peritoneal dialysis. 一名接受腹膜透析的患者的肺积水和难治性胸腔积液。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-10-01 Epub Date: 2023-04-21 DOI: 10.1111/1744-9987.13998

Yuya Sato, Yusuke Takahashi, Kazuyuki Tasaki

Dear Editor, Patients with chronic kidney disease often develop pleural effusion [1], although the latter can also develop in a variety of other conditions [2]. One of these is trapped lung, which may often go undetected. To our knowledge, no case of trapped lung in a patient undergoing regular peritoneal dialysis has been documented in detail hitherto. A 65-year-old male patient with renal failure had been receiving peritoneal dialysis for 6 years before presentation. Although his clinical course had been uneventful, chronic unilateral right pleural effusion had developed several months previously. Therefore, his dose of diuretics had been increased, and the dialysate converted to one with a high glucose concentration. However, the pleural fluid persisted. He was advised to switch to hemodialysis, but declined to do so, mostly because of difficulty with frequent hospital visits. As the pleural fluid was unresponsive to thoracentesis, we performed catheter insertion and drained the fluid sufficiently. During the entire period of drainage, there were no signs suggestive of pneumothorax such as air leakage. Chest computed tomography was performed and this allowed us to make a diagnosis of trapped lung (Figure 1). We suspected that air had entered the thoracic cavity via the catheter from outside as a result of negative pressure that had developed due to the trapped lung. Culture of the pleural fluid was negative for bacteria and mycobacteria, and no malignant cells were evident. The concentration of glucose in the pleural fluid was quite low relative to that of the dialysate, suggesting a lack of pleuroperitoneal communication. After removal of the catheter, the pleural effusion increased again to the previous level within a short period. We started the patient on hemodialysis, but despite intensified body fluid removal, the pleural effusion remained. As the patient complained of only mild exertional dyspnea, we decided that close observation alone would be appropriate. Trapped lung is a condition in which a fibrous layer of visceral pleura surrounds the lung and restricts its expansion [3], resulting in excessive negative intrapleural pressure, and constant formation of pleural fluid. This condition can be associated with several diseases, including pleural infections such as empyema or parapneumonic effusion, immunologic pleuritis, hemothorax, radiation pleuritis or uremia. The present patient's clinical course suggested that no causes other than renal failure had triggered the pleural thickening or the trapped lung. As a relationship between pleural fibrosis and renal failure has been described in the context of uremic pleuritis [4], it may be rational to consider that inadequate efficacy of dialysis might contribute to pleural thickening through sustained pleural inflammation. Therefore, we speculate that if hemodialysis had been started earlier in the present case, it may have prevented development of the trapped lung. However, regardless of t

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引用次数: 0

Therapeutic Apheresis and Dialysis Forthcoming Events October 2023 治疗性采血和透析即将举行的活动2023年10月

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-09-03 DOI: 10.1111/1744-9987.13879

October

引用次数: 0

Recent changes in the frequency of use of apheresis and biological drugs in the treatment of neuromyelitis optica spectrum disorders. 近年来在治疗视神经谱系障碍的神经脊髓炎中使用单采和生物药物的频率的变化。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13977

Katsuichi Miyamoto, Nobuaki Nakayama, Hidefumi Ito

Dear Editor, Neuromyelitis optica spectrum disorders (NMOSD) is an immunological neurological disease caused by antiaquqporin-4 (AQP4) antibodies which trigger severe damage to the optic nerve and spinal cord. Steroid pulses are used as treatment in the acute phase of the disease, but not a few cases are unsuccessful, for which apheresis is often later performed [1]. Steroids and immunosuppressive drugs are conventionally used to prevent NMOSD recurrence, but are sometimes inadequate. Biological drugs (biologics) that have emerged in recent years have been shown to be effective in refractory cases. In Japan, biologics were approved for the prevention of relapse starting in November 2019 for eculizumab, an anti-C5 antibody, followed by satralizumab, an anti-IL-6 receptor antibody in August 2020, inebilizumab, an antiCD-19 antibody in March 2021, and rituximab, an antiCD20 antibody in June 2022 [2]. Herein, we present how the clinical characteristics and treatment of NMOSD have changed with the advent of biologics, and discuss the role of apheresis in this treatment. We retrospectively examined patients with NMOSD, diagnosed using the 2015 diagnostic criteria [3], who attended our hospital. Clinical information was

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引用次数: 0

The effect of food intake during hemodialysis on blood pressure: A nonrandomized experimental trial. 血液透析期间食物摄入对血压的影响:一项非随机实验试验。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13967

Melek Avci, Fatma Arikan

Background: Intradialytic hypotension (IDH) is one of the most important intradialytic complications and is thought to be associated with intradialytic food intake. Allowing intradialytic feeding is still unclear. This study aimed to determine the relationship between IDH and intradialytic food intake.

Methods: A nonrandomized experimental study was conducted to determine the effect of intradialytic food intake on blood pressure (BP) in hemodialysis patients. Each patient was assessed twice using an ambulatory BP monitor with and without intradialytic food intake.

Results: The study was completed with 54 patients. Intradialytic hypotension developed in 40 patients (74.1%) during the food intake session, while intradialytic hypotension developed in 22 participants (40%) in the no-food session. Repeated BP readings showed that eating 2 h or more after the start of hemodialysis significantly reduced BP.

Conclusions: Intradialytic food intake affects the development of IDH. Patients who ate during hemodialysis had a trend of higher of IDH than those who ate nothing during hemodialysis. Eating during dialysis is not recommended.

背景:分析性低血压(IDH)是最重要的分析性并发症之一，被认为与分析性食物摄入有关。目前尚不清楚是否允许透析喂养。本研究旨在确定IDH与胃内食物摄入之间的关系。方法:采用非随机实验研究，探讨透析患者血溶期食物摄入对血压的影响。每位患者使用动态血压监测仪评估两次，有或没有分析性食物摄入。结果:54例患者完成研究。有40名患者(74.1%)在进食期间出现了分析性低血压，而22名参与者(40%)在不进食期间出现了分析性低血压。重复的血压读数显示，在血液透析开始后2小时或更长时间进食可显著降低血压。结论:消化期食物摄入影响IDH的发展。血液透析期间进食的患者IDH高于不进食的患者。不建议在透析期间进食。

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引用次数: 1

The significance of volume overload in the development of pulmonary arterial hypertension in continuous ambulatory peritoneal dialysis patients. 容量超载在持续非卧床腹膜透析患者肺动脉高压发展中的意义。

IF 1.9 4区医学 Q3 HEMATOLOGY

Therapeutic Apheresis and Dialysis

Pub Date : 2023-08-01 DOI: 10.1111/1744-9987.13965

Mohammad Nekooeian, Shahrokh Ezzatzadegan Jahromi, Fatemeh Masjedi, Maryam Sohooli, Ramin Shekouhi, Alireza Moaref

Introduction: The underlying pathophysiology of pulmonary arterial hypertension (PAH) is multifactorial; however, the significance of chronic volume overload and its subsequent effects on cardiac function must be studied thoroughly. The main objective of this study was to determine the predictive parameters of PAH in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using transthoracic echocardiography (TTE) and bioimpedance analysis (BIA).

Methods: In this cross-sectional study, 43 eligible CAPD patients were chosen. The patients were examined by TTE and BIA before the morning dialysis session, and baseline patient characteristics, echocardiography, and BIA parameters were recorded.

Results: Sixteen (37.2%) patients were diagnosed with PAH. Patients with PAH had significantly greater left atrial diameter (LAD), left ventricular mass index (LVMI), and higher grades of diastolic dysfunction (DDF). Systolic pulmonary artery pressure (sPAP) correlated with LAD (p < 0.001, r = 0.566), interventricular septal diameter (IVSD) (p = 0.004, r = 0.425), LVMI (p = 0.030, r = 0.323), and extracellular water/total body water (ECW/TBW) ratio (p = 0.002, r = 0.458).

Conclusion: Two volume status-related parameters including ECW/TBW ratio and inferior vena cava (IVC) expiratory diameter, and cardiac-related TTE findings such as LAD and DDF were predictors of sPAP in CAPD patients.

肺动脉高压(PAH)的潜在病理生理是多因素的;然而，慢性容量过载的意义及其对心功能的影响必须深入研究。本研究的主要目的是利用经胸超声心动图(TTE)和生物阻抗分析(BIA)确定连续动态腹膜透析(CAPD)患者PAH的预测参数。方法:本横断面研究选取43例符合条件的CAPD患者。患者在晨透析前接受TTE和BIA检查，并记录患者基线特征、超声心动图和BIA参数。结果:16例(37.2%)患者诊断为PAH。PAH患者的左房内径(LAD)、左室质量指数(LVMI)和舒张功能障碍(DDF)程度均显著增大。结论:ECW/TBW比值、下腔静脉(IVC)呼气直径两项容积状态相关参数以及LAD、DDF等心脏相关TTE指标是CAPD患者sPAP的预测指标。

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引用次数: 2

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