Iman Hajizadeh, Mahdieh Jamshidi, Majid Kazemi, Hossein Kargar, Tabandeh Sadeghi
Introduction: This study aimed to compare the effect of valerian and gabapentin on restless legs syndrome (RLS) and sleep quality in HD patients.
Methods: In this cross over clinical trial study, 40 HD patients allocated into a valerian and gabapentin group. In the first phase of the study, Group A received valerian and Group B received gabapentin 1 h before bedtime for 1 month. In the second phase, the two groups' treatment regimen was swapped. After a 1-month washout period, the same process was repeated on the crossover groups.
Results: After the first phase, the mean score of RLS was lower in the gabapentin group. But there was no statistically significant difference between the two groups in terms of sleep quality score before and after the first and second interventions.
Conclusion: Gabapentin is more effective than valerian in improving RLS, but both are equally effective in improving sleep quality.
{"title":"Comparison the effect of valerian and gabapentin on RLS and sleep quality in hemodialysis patients: A randomized clinical trial.","authors":"Iman Hajizadeh, Mahdieh Jamshidi, Majid Kazemi, Hossein Kargar, Tabandeh Sadeghi","doi":"10.1111/1744-9987.13987","DOIUrl":"https://doi.org/10.1111/1744-9987.13987","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the effect of valerian and gabapentin on restless legs syndrome (RLS) and sleep quality in HD patients.</p><p><strong>Methods: </strong>In this cross over clinical trial study, 40 HD patients allocated into a valerian and gabapentin group. In the first phase of the study, Group A received valerian and Group B received gabapentin 1 h before bedtime for 1 month. In the second phase, the two groups' treatment regimen was swapped. After a 1-month washout period, the same process was repeated on the crossover groups.</p><p><strong>Results: </strong>After the first phase, the mean score of RLS was lower in the gabapentin group. But there was no statistically significant difference between the two groups in terms of sleep quality score before and after the first and second interventions.</p><p><strong>Conclusion: </strong>Gabapentin is more effective than valerian in improving RLS, but both are equally effective in improving sleep quality.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797834","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}
Dear Editor, It is widely known that shared decision-making (SDM) is a superior approach when choosing the dialysis modality in patients with end-stage kidney disease (ESKD). However, its impact on patient satisfaction has not been well investigated. We conducted this survey to clarify patient satisfaction with a 1-h discussion on the choice of dialysis modality at the outpatient clinic. This anonymous survey included ESKD patients who visited our outpatient clinic between February 10, 2020 and March 31, 2022. Details of the outpatient clinic have been described in a previous report [1]. Return of a completed questionnaire by the patient was considered as consent for study participation. Of the 74 patients who returned the questionnaire, 65 patients who fully completed it were included in the analysis. This survey was based on the Ministry of Health, Labor and Welfare's survey, evaluated on a 5-point scale (very satisfied, satisfied, neutral, somewhat dissatisfied, and very dissatisfied). Patient background items, such as age group, sex, underlying disease causing ESKD, history of nephrology visits, employment status, and cohabitation status. Subjective understanding of the clinical implications of hemodialysis (HD) and peritoneal dialysis (PD) before and after outpatient visits (rated on a 10-point scale) was also included. Forty-six patients were over 70 years old, 49 were male, and diabetic nephropathy was the cause of ESKD in 17 patients. Forty-eight patients had a history of nephrology consultations for more than 1 year, 19 were employed, and 58 lived with someone. Subjective comprehension of dialysis modality significantly increased after outpatient visits compared to before the visits (HD: 7.7 ± 1.8 vs. 4.9 ± 2.4 points, PD: 7.0 ± 2.3 vs. 3.7 ± 2.6 points, p < 0.01, respectively). Eighty-three percent of the patients responded that they were satisfied or very satisfied (Figure 1). Ordinal logistic regression analysis of factors associated with patient satisfaction revealed that patients with less than 1 year of nephrology outpatient visits had higher patient satisfaction than those with longer histories of consultations (odds ratio = 3.672 [95% confidence interval: 1.143, 11.792, p = 0.029]). A survey has been performed to assess treatment satisfaction for dialysis patients [2]. However, few studies have been performed to assess patient satisfaction with SDM for non-dialysis patients. The present study showed that patient satisfaction was not associated with improved subjective comprehension and was higher in patients with a short history of nephrology visits. It has been reported that patient satisfaction is associated with attendance at dialysis sessions [3]. Furthermore, surveying patient satisfaction provides feedback from ESKD patients and may lead to improved quality of care. However, the outcomes cannot be assessed due to this anonymous study. Late referral patients often do not have sufficient acceptance of ESKD, and we speculated
{"title":"Survey on patient satisfaction with a one-hour discussion on the choice of dialysis modality at the outpatient clinic.","authors":"Tsutomu Sakurada, Kaori Kohatsu, Shigeki Kojima","doi":"10.1111/1744-9987.13985","DOIUrl":"https://doi.org/10.1111/1744-9987.13985","url":null,"abstract":"Dear Editor, It is widely known that shared decision-making (SDM) is a superior approach when choosing the dialysis modality in patients with end-stage kidney disease (ESKD). However, its impact on patient satisfaction has not been well investigated. We conducted this survey to clarify patient satisfaction with a 1-h discussion on the choice of dialysis modality at the outpatient clinic. This anonymous survey included ESKD patients who visited our outpatient clinic between February 10, 2020 and March 31, 2022. Details of the outpatient clinic have been described in a previous report [1]. Return of a completed questionnaire by the patient was considered as consent for study participation. Of the 74 patients who returned the questionnaire, 65 patients who fully completed it were included in the analysis. This survey was based on the Ministry of Health, Labor and Welfare's survey, evaluated on a 5-point scale (very satisfied, satisfied, neutral, somewhat dissatisfied, and very dissatisfied). Patient background items, such as age group, sex, underlying disease causing ESKD, history of nephrology visits, employment status, and cohabitation status. Subjective understanding of the clinical implications of hemodialysis (HD) and peritoneal dialysis (PD) before and after outpatient visits (rated on a 10-point scale) was also included. Forty-six patients were over 70 years old, 49 were male, and diabetic nephropathy was the cause of ESKD in 17 patients. Forty-eight patients had a history of nephrology consultations for more than 1 year, 19 were employed, and 58 lived with someone. Subjective comprehension of dialysis modality significantly increased after outpatient visits compared to before the visits (HD: 7.7 ± 1.8 vs. 4.9 ± 2.4 points, PD: 7.0 ± 2.3 vs. 3.7 ± 2.6 points, p < 0.01, respectively). Eighty-three percent of the patients responded that they were satisfied or very satisfied (Figure 1). Ordinal logistic regression analysis of factors associated with patient satisfaction revealed that patients with less than 1 year of nephrology outpatient visits had higher patient satisfaction than those with longer histories of consultations (odds ratio = 3.672 [95% confidence interval: 1.143, 11.792, p = 0.029]). A survey has been performed to assess treatment satisfaction for dialysis patients [2]. However, few studies have been performed to assess patient satisfaction with SDM for non-dialysis patients. The present study showed that patient satisfaction was not associated with improved subjective comprehension and was higher in patients with a short history of nephrology visits. It has been reported that patient satisfaction is associated with attendance at dialysis sessions [3]. Furthermore, surveying patient satisfaction provides feedback from ESKD patients and may lead to improved quality of care. However, the outcomes cannot be assessed due to this anonymous study. Late referral patients often do not have sufficient acceptance of ESKD, and we speculated ","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9814218","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}
Hiroaki Haruguchi, Kotaro Suemitsu, Naoko Isogai, Masaaki Murakami, Masahiko Fujihara, Kazuhiro Iwadoh, Jeremiah Menk, Hiroko Ookubo, Tomonari Ogawa, Levester Kirksey, Sanjay Misra, Angelo Santos, Chad Laurich, Omran Abul-Khoudoud, Adie Friedman, Vincent Gallo, Ahmed Kamel Abdel Aal, Mel Sharafuddin, Sreekumar Madassery, David Dexter, Charles Joels, Syed Hussain, Sandeep Bagla, Jeffrey Hull, John Ross, Jeffrey Hoggard, Bret Wiechmann, Naveen Atray, Randy Cooper, Neghae Mawla, Fernando Kafie, Kotaro Suemitsu, Naoko Isogai, Masahiko Fujihara, Masaaki Murakami, Shohei Fuchinoue, Kazuhiro Iwadoh, Tomonari Ogawa, Andrew Holden, Kesaka Wickremesekera
Purpose: There is a lack of adjudicated and prospectively randomized published outcomes on the use of drug-coated balloons (DCB) to treat dysfunctional arteriovenous fistula in Asian patients. This post hoc subgroup analysis of 112 Japanese participants from the global IN.PACT AV Access trial reports outcomes through 12 months.
Materials and methods: Participants were treated with DCB (n = 58) or standard non-coated percutaneous transluminal angioplasty (PTA) balloons (n = 54). Outcomes included target lesion primary patency (TLPP), access circuit primary patency, and safety.
Results: Through 6 months, TLPP was 86.0% (49/57) in the DCB group and 49.1% (26/53) in the PTA group (p < 0.001). Through 12 months, TLPP was 67.3% (37/55) in the DCB group and 43.4% (23/53) in the PTA group (p = 0.013).
Conclusion: In this post hoc analysis of Japanese participants from the IN.PACT AV Access trial, participants treated with DCB had higher TLPP through 6 and 12 months compared with PTA.
目的:在亚洲患者中，使用药物包被球囊(DCB)治疗功能障碍动静脉瘘缺乏经过裁决和前瞻性随机发表的结果。这是对112名来自全球IN的日本参与者的事后亚组分析。PACT AV Access试验报告为期12个月的结果。材料和方法:参与者接受DCB (n = 58)或标准无涂层经皮腔内血管成形术(PTA)球囊治疗(n = 54)。结果包括靶病变初级通畅(TLPP)、通路初级通畅和安全性。结果:6个月后，DCB组的TLPP为86.0% (49/57)，PTA组的TLPP为49.1%(26/53)。在PACT AV准入试验中，与PTA相比，DCB治疗的参与者在6个月和12个月的TLPP更高。
{"title":"IN.PACT AV access randomized trial: Japan cohort outcomes through 12 months.","authors":"Hiroaki Haruguchi, Kotaro Suemitsu, Naoko Isogai, Masaaki Murakami, Masahiko Fujihara, Kazuhiro Iwadoh, Jeremiah Menk, Hiroko Ookubo, Tomonari Ogawa, Levester Kirksey, Sanjay Misra, Angelo Santos, Chad Laurich, Omran Abul-Khoudoud, Adie Friedman, Vincent Gallo, Ahmed Kamel Abdel Aal, Mel Sharafuddin, Sreekumar Madassery, David Dexter, Charles Joels, Syed Hussain, Sandeep Bagla, Jeffrey Hull, John Ross, Jeffrey Hoggard, Bret Wiechmann, Naveen Atray, Randy Cooper, Neghae Mawla, Fernando Kafie, Kotaro Suemitsu, Naoko Isogai, Masahiko Fujihara, Masaaki Murakami, Shohei Fuchinoue, Kazuhiro Iwadoh, Tomonari Ogawa, Andrew Holden, Kesaka Wickremesekera","doi":"10.1111/1744-9987.13966","DOIUrl":"https://doi.org/10.1111/1744-9987.13966","url":null,"abstract":"<p><strong>Purpose: </strong>There is a lack of adjudicated and prospectively randomized published outcomes on the use of drug-coated balloons (DCB) to treat dysfunctional arteriovenous fistula in Asian patients. This post hoc subgroup analysis of 112 Japanese participants from the global IN.PACT AV Access trial reports outcomes through 12 months.</p><p><strong>Materials and methods: </strong>Participants were treated with DCB (n = 58) or standard non-coated percutaneous transluminal angioplasty (PTA) balloons (n = 54). Outcomes included target lesion primary patency (TLPP), access circuit primary patency, and safety.</p><p><strong>Results: </strong>Through 6 months, TLPP was 86.0% (49/57) in the DCB group and 49.1% (26/53) in the PTA group (p < 0.001). Through 12 months, TLPP was 67.3% (37/55) in the DCB group and 43.4% (23/53) in the PTA group (p = 0.013).</p><p><strong>Conclusion: </strong>In this post hoc analysis of Japanese participants from the IN.PACT AV Access trial, participants treated with DCB had higher TLPP through 6 and 12 months compared with PTA.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9739291","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}
Benjamin Giszas, Philipp A Reuken, Katrin Katzer, Michael Kiehntopf, Diana Schmerler, Silke Rummler, Andreas Stallmach, Anne Klink
Introduction: Following SARS-CoV-2-infection up to 21% of patients will develop post-COVID-syndrome. Autoantibodies (AAbs) targeting neuronal-ß-adrenergic and muscarinic receptors may provide crucial contributions to the pathophysiology of this condition. Immunoadsorption (IA) has been identified as an effective means of removing AAbs and has resulted in clinical improvements of other autoantibody-associated diseases.
Methods: We determined AAb-levels (anti-ß1/ß2 and anti-M3/M4 receptor) in 178 patients diagnosed with post-COVID-syndrome and described the clinical courses of two patients with elevated AAb-levels that underwent IA-treatment.
Results: AAbs were detected in 57% (101/178) of patients diagnosed with post-COVID-syndrome. Substantial reductions in AAb-levels and clinical remission were achieved in one of two patients who was treated with IA. However, this patient relapsed within 6 weeks with a concomitant increase in AAb-levels.
Conclusion: Collectively, AAbs may play a pathophysiologic role in post-COVID and their removal provide transient benefits in some patients. However, these findings should be further investigated in randomized-controlled-trials.
{"title":"Immunoadsorption to treat patients with severe post-COVID syndrome.","authors":"Benjamin Giszas, Philipp A Reuken, Katrin Katzer, Michael Kiehntopf, Diana Schmerler, Silke Rummler, Andreas Stallmach, Anne Klink","doi":"10.1111/1744-9987.13974","DOIUrl":"https://doi.org/10.1111/1744-9987.13974","url":null,"abstract":"<p><strong>Introduction: </strong>Following SARS-CoV-2-infection up to 21% of patients will develop post-COVID-syndrome. Autoantibodies (AAbs) targeting neuronal-ß-adrenergic and muscarinic receptors may provide crucial contributions to the pathophysiology of this condition. Immunoadsorption (IA) has been identified as an effective means of removing AAbs and has resulted in clinical improvements of other autoantibody-associated diseases.</p><p><strong>Methods: </strong>We determined AAb-levels (anti-ß1/ß2 and anti-M3/M4 receptor) in 178 patients diagnosed with post-COVID-syndrome and described the clinical courses of two patients with elevated AAb-levels that underwent IA-treatment.</p><p><strong>Results: </strong>AAbs were detected in 57% (101/178) of patients diagnosed with post-COVID-syndrome. Substantial reductions in AAb-levels and clinical remission were achieved in one of two patients who was treated with IA. However, this patient relapsed within 6 weeks with a concomitant increase in AAb-levels.</p><p><strong>Conclusion: </strong>Collectively, AAbs may play a pathophysiologic role in post-COVID and their removal provide transient benefits in some patients. However, these findings should be further investigated in randomized-controlled-trials.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9968491","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}
David F Painter, Braden Vogt, Anagha Lokhande, Rodrigo Saad Berreta, Ankur D Shah
The COVID-19 pandemic exerted complex pressures on the nephrology community. Despite multiple prior reviews on acute peritoneal dialysis during the pandemic, the effects of COVID-19 on maintenance peritoneal dialysis patients remain underexamined. This review synthesizes and reports findings from 29 total cases of chronic peritoneal dialysis patients with COVID-19, encompassing 3 case reports, 13 case series, and 13 cohort studies. When available, data for patients with COVID-19 on maintenance hemodialysis are also discussed. Finally, we present a chronological timeline of evidence regarding the presence of SARS-CoV-2 in spent peritoneal dialysate and explore trends in telehealth as they relate to peritoneal dialysis patients during the pandemic. We conclude that the COVID-19 pandemic has underscored the efficacy, flexibility, and utility of peritoneal dialysis.
{"title":"Impact of COVID-19 on maintenance peritoneal dialysis patients and providers: A review.","authors":"David F Painter, Braden Vogt, Anagha Lokhande, Rodrigo Saad Berreta, Ankur D Shah","doi":"10.1111/1744-9987.13993","DOIUrl":"https://doi.org/10.1111/1744-9987.13993","url":null,"abstract":"<p><p>The COVID-19 pandemic exerted complex pressures on the nephrology community. Despite multiple prior reviews on acute peritoneal dialysis during the pandemic, the effects of COVID-19 on maintenance peritoneal dialysis patients remain underexamined. This review synthesizes and reports findings from 29 total cases of chronic peritoneal dialysis patients with COVID-19, encompassing 3 case reports, 13 case series, and 13 cohort studies. When available, data for patients with COVID-19 on maintenance hemodialysis are also discussed. Finally, we present a chronological timeline of evidence regarding the presence of SARS-CoV-2 in spent peritoneal dialysate and explore trends in telehealth as they relate to peritoneal dialysis patients during the pandemic. We conclude that the COVID-19 pandemic has underscored the efficacy, flexibility, and utility of peritoneal dialysis.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118625","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}
Mitică Ciorpac, Cezar-Cătălin Caratașu, Andrei Szilagyi, Cosmin-Teodor Mihai, Ionut Nistor, Radu Iliescu, Bogdan Ionel Tamba
Introduction: Therapeutic plasma exchange (TPE) has been developed more than 100 years ago in an animal model and adapted to humans 30 years later. Since then, the TPE research on animal models is lacking, mainly due to difficulties raised by the scaling of the plasmapheresis unit so that the animal's cardiovascular parameters are not considerably affected.
Methods: The system concept of a novel TPE device with continuous hemodynamic monitoring in small rodent models has been used.
Results: A continuum TPE unit for rats has been developed, able to produce up to 95% plasma exchange rate without any TPE-related hemodynamic impairment, monitored up to 35 days after the procedure.
Conclusion: The TPE unit for rats was able to produce 95% plasma exchange rate in non-anesthetized animals, enabling a full translation of the human TPE into an animal model. The newly developed plasmapheresis unit enable a wide range of more accurate preclinical evaluation, with cardiac parameters monitoring, using small rodents in awaken state.
{"title":"A novel device and system concept for therapeutic plasma exchange in rats.","authors":"Mitică Ciorpac, Cezar-Cătălin Caratașu, Andrei Szilagyi, Cosmin-Teodor Mihai, Ionut Nistor, Radu Iliescu, Bogdan Ionel Tamba","doi":"10.1111/1744-9987.13989","DOIUrl":"https://doi.org/10.1111/1744-9987.13989","url":null,"abstract":"<p><strong>Introduction: </strong>Therapeutic plasma exchange (TPE) has been developed more than 100 years ago in an animal model and adapted to humans 30 years later. Since then, the TPE research on animal models is lacking, mainly due to difficulties raised by the scaling of the plasmapheresis unit so that the animal's cardiovascular parameters are not considerably affected.</p><p><strong>Methods: </strong>The system concept of a novel TPE device with continuous hemodynamic monitoring in small rodent models has been used.</p><p><strong>Results: </strong>A continuum TPE unit for rats has been developed, able to produce up to 95% plasma exchange rate without any TPE-related hemodynamic impairment, monitored up to 35 days after the procedure.</p><p><strong>Conclusion: </strong>The TPE unit for rats was able to produce 95% plasma exchange rate in non-anesthetized animals, enabling a full translation of the human TPE into an animal model. The newly developed plasmapheresis unit enable a wide range of more accurate preclinical evaluation, with cardiac parameters monitoring, using small rodents in awaken state.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742529","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}
{"title":"Correction to \"Prostacyclin analog beraprost sodium efficacy in primary glomerular disease or nephrosclerosis: Analysis of the Japanese subgroup in CASSIOPEIR study\".","authors":"","doi":"10.1111/1744-9987.13986","DOIUrl":"https://doi.org/10.1111/1744-9987.13986","url":null,"abstract":"","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10479993/pdf/TAP-27-825.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10175525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Guillain–Barré syndrome (GBS) is post-infectious immune-mediated acute onset polyradiculoneuropathy typically presenting with ascending paralysis and sensory deficits. The diagnosis relies on typical clinical presentation, electrophysiological studies, and cerebrospinal fluid (CSF) examination. Evidence suggests an association between SARS-CoV-2 infection and the development of GBS [1]. We report the first case of GBS after SARSCoV-2 infection in a kidney transplant recipient successfully treated with therapeutic plasma exchange (TPE). A 60-year-old male received a kidney from a deceased donor. Primary graft function was established with no posttransplant complications. Thirteen months after transplantation and 2 months after receiving mRNA vaccine he presented with severe SARS-CoV-2 infection. Fifteen days after the SARS-CoV-2 infection symptoms onset, he presented with ascending leg weakness progressing to tetraparesis. CSF analysis revealed elevated protein levels with normal cell count. Electrophysiological studies were not available to perform due to the limitations of the pandemic setting. Based on clinical presentation and CSF finding GBS was diagnosed. At the time of diagnosis, our country was facing an intravenous immunoglobulin (IVIG) shortage, and the treatment of choice was TPE. The patient was treated with seven courses of TPE, followed by physical therapy. The outcome was complete neurological recovery. Graft function remained stable. GBS usually occurs sporadically. However, evidence suggests increased incidence related to various epidemics worldwide. Numerous case reports and reviews report on GBS related to SARS-CoV-2 infection during the pandemic's peak. Several potential mechanisms are associated with the pathogenesis of GBS after SARS-CoV-2 infection. Present findings suggest post-infectious immune-mediated mechanisms rather than direct induction by the virus [2, 3]. The reported time between SARS-CoV-2 symptoms and GBS onset ranges between 2 and 33 days. The average age of affected patients is 55 years with male predominance. Most of the patients had symptomatic SARS-CoV-2 infection; however, asymptomatic cases were also reported. According to the current data relationship between the severity of the disease and the outcome is unclear. Most patients presented with the classical sensorimotor and demyelining form, although some variants of GBS have also been reported [3]. At the time of diagnosis, our patient was 61 years old, presenting with GBS 15 days after the SARS-CoV-2 infection diagnosis. The ongoing SARS-CoV-2 pandemic forced healthcare systems worldwide to face many challenges and adjust to new realities including shortage of drugs, diagnostic and therapeutical procedures and medical staff. Most reported patients with GBS related to SARS-CoV-2 infection were treated with IVIG, with favorable outcomes in 70% of them [3]. TPE is a treatment option, but in the setting of the COVID pandemic potential problems
{"title":"Guillain-Barré syndrome following SARS-CoV-2 infection in kidney transplant recipient successfully treated with therapeutic plasma exchange.","authors":"Ivana Juric, Nikolina Basic-Jukic","doi":"10.1111/1744-9987.13972","DOIUrl":"https://doi.org/10.1111/1744-9987.13972","url":null,"abstract":"Dear Editor, Guillain–Barré syndrome (GBS) is post-infectious immune-mediated acute onset polyradiculoneuropathy typically presenting with ascending paralysis and sensory deficits. The diagnosis relies on typical clinical presentation, electrophysiological studies, and cerebrospinal fluid (CSF) examination. Evidence suggests an association between SARS-CoV-2 infection and the development of GBS [1]. We report the first case of GBS after SARSCoV-2 infection in a kidney transplant recipient successfully treated with therapeutic plasma exchange (TPE). A 60-year-old male received a kidney from a deceased donor. Primary graft function was established with no posttransplant complications. Thirteen months after transplantation and 2 months after receiving mRNA vaccine he presented with severe SARS-CoV-2 infection. Fifteen days after the SARS-CoV-2 infection symptoms onset, he presented with ascending leg weakness progressing to tetraparesis. CSF analysis revealed elevated protein levels with normal cell count. Electrophysiological studies were not available to perform due to the limitations of the pandemic setting. Based on clinical presentation and CSF finding GBS was diagnosed. At the time of diagnosis, our country was facing an intravenous immunoglobulin (IVIG) shortage, and the treatment of choice was TPE. The patient was treated with seven courses of TPE, followed by physical therapy. The outcome was complete neurological recovery. Graft function remained stable. GBS usually occurs sporadically. However, evidence suggests increased incidence related to various epidemics worldwide. Numerous case reports and reviews report on GBS related to SARS-CoV-2 infection during the pandemic's peak. Several potential mechanisms are associated with the pathogenesis of GBS after SARS-CoV-2 infection. Present findings suggest post-infectious immune-mediated mechanisms rather than direct induction by the virus [2, 3]. The reported time between SARS-CoV-2 symptoms and GBS onset ranges between 2 and 33 days. The average age of affected patients is 55 years with male predominance. Most of the patients had symptomatic SARS-CoV-2 infection; however, asymptomatic cases were also reported. According to the current data relationship between the severity of the disease and the outcome is unclear. Most patients presented with the classical sensorimotor and demyelining form, although some variants of GBS have also been reported [3]. At the time of diagnosis, our patient was 61 years old, presenting with GBS 15 days after the SARS-CoV-2 infection diagnosis. The ongoing SARS-CoV-2 pandemic forced healthcare systems worldwide to face many challenges and adjust to new realities including shortage of drugs, diagnostic and therapeutical procedures and medical staff. Most reported patients with GBS related to SARS-CoV-2 infection were treated with IVIG, with favorable outcomes in 70% of them [3]. TPE is a treatment option, but in the setting of the COVID pandemic potential problems ","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9971407","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}
Emad Samaan, Ahmed A Eldeeb, Ahmed B Ibrahim, Mohammed Erman, Alaa A Sabry, Mostafa A Mahmoud
Background: Chronic kidney disease (CKD) is associated with a state of chronic inflammation. This study aimed to investigate effects of Ramadan fasting on the markers of chronic inflammation and gut bacterial endotoxin levels in maintenance hemodialysis.
Method: A prospective self-controlled observational study included 45 patients. Serum levels of High Sensitive CRP (hsCRP), indoxyl sulfate, and trimethylamine-n-levels were measured within a week before and a week after Ramadan fasting.
Results: Twenty-seven patients have fasted more than 15 days (29 ± 2.2 days). The levels of high sensitive C-reactive protein (hsCRP) (median of 62 mg/L vs. 91 mg/L), trimethylamine-n-oxide (TMAO) (median of 4.5 μmoL/L vs. 17 μmoL/L), platelet-to-lymphocyte ratio (PLR) (mean of 98.9 mg/L vs. 111.8 mg/L) and neutrophil-to-lymphocyte ratio (NLR) (median of 1.56 vs. 1.59) were significantly lower after Ramadan fasting with p < 0.001, p < 0.001, p < 0.001, and p = 0.04, respectively.
Conclusion: A beneficial effect of Ramadan fasting on levels of bacterial endotoxins and markers of chronic inflammation in hemodialysis patients was observed.
背景:慢性肾脏疾病(CKD)与慢性炎症状态相关。本研究旨在探讨斋月禁食对维持性血液透析患者慢性炎症标志物和肠道细菌内毒素水平的影响。方法:采用前瞻性自我对照观察性研究，纳入45例患者。在斋月禁食前一周和禁食后一周内测定血清中高敏CRP (hsCRP)、硫酸吲哚酚和三甲胺n水平。结果:27例患者禁食超过15天(29±2.2天)。斋月禁食后，高敏感c反应蛋白(hsCRP)水平(中位数为62 mg/L vs. 91 mg/L)、三甲胺-氧化三甲胺(TMAO)水平(中位数为4.5 μmoL/L vs. 17 μmoL/L)、血小板-淋巴细胞比率(PLR)水平(平均为98.9 mg/L vs. 111.8 mg/L)和中性粒细胞-淋巴细胞比率(NLR)水平(中位数为1.56 vs. 1.59)均显著降低，p < 0.05。观察到斋月禁食对血液透析患者细菌内毒素水平和慢性炎症标志物的有益影响。
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Dear Editor Better dialysis technique has contributed to improved outcomes of pregnancies in hemodialysis patients. However, conception rates are still limited and pregnancies are associated with a high risk of complications. Primary hyperoxalurias (PH) are a group of rare diseases caused by a genetic abnormality that results in excessive oxalate production. The most severe form, PH1, is caused by a mutation in alanine-glyoxylate aminotransferase gene which leads to progression to end-stage kidney disease by age of 60 years in 88% of patients [1, 2]. We present a case of a 25-year-old woman with chronic kidney disease secondary to PH1, diagnosed at the age of three when she presented with nephrolithiasis. The genetic analysis detected two mutations in the homozygous state in an AGTX gene: AGTX NM_000030.3:c.33dupC, p.(Lys12FInfs*156). Her parents were not blood relatives. She underwent multiple lithotripsies for the treatment of nephrolithiasis but was not in regular follow-ups due to noncompliance. In March 2020, she presented at the Emergency Department Unit in the terminal stage of kidney failure with the need for hemodialysis. The chronic hemodialysis protocol included four sessions weekly lasting for 4.5 h. Her menstrual cycles were irregular. On September 13, 2022, she reported amenorrhea. A gynecological workup revealed that she was approximately 24 weeks pregnant. She did not undergo genetic counseling before conception nor received any new medications. The hemodialysis program was intensified to five sessions per week, increasing dialysis time to 5 h. A Theranova 400 membrane (Baxter) was used and a dialysate bath was adjusted depending on laboratory results. Nadroparin was administered as an anticoagulant agent at a dose of 0.4 mL per session. She received paricalcitol, vitamin B6 3 50 mg, folic acid, pantoprazole 20 mg, and an oral nutritional supplement. Predialysis urea levels were maintained below 12.5 mmol/L. We also aimed to maintain normal calcium levels and hemoglobin concentration at approximately 110 g/L. Her dry weight was increased by 500 mg every 7 days corresponding to an increase in weight during normal pregnancies. The patient was hospitalized at 37 weeks of gestation and gave birth to a healthy 2450-g male baby 2 days later by Cesarean section. The postpartum course was uneventful. Her regular hemodialysis has been continued four times weekly. She is waiting for simultaneous liver–kidney transplantation and the approval of the use of lumasiran, with the skin ulcer on her leg indicating systemic oxalosis. Current treatment options for PH1 are limited. Simultaneous liver–kidney transplantation is used for patients with end-stage kidney failure [2]. Lumasiran is a novel liver-directed RNA interference therapeutic agent. It reduces hepatic oxalate production and increases concentrations of glycolate in patients with PH1, by degrading the messenger RNA that encodes glycolate oxidase, an enzyme upstream of alanineglyoxylate a
{"title":"Successful pregnancy in a hemodialysis patient with primary hyperoxaluria type 1.","authors":"Franka Zuban, Ranko Ladavac, Nikolina Basic-Jukic","doi":"10.1111/1744-9987.13995","DOIUrl":"https://doi.org/10.1111/1744-9987.13995","url":null,"abstract":"Dear Editor Better dialysis technique has contributed to improved outcomes of pregnancies in hemodialysis patients. However, conception rates are still limited and pregnancies are associated with a high risk of complications. Primary hyperoxalurias (PH) are a group of rare diseases caused by a genetic abnormality that results in excessive oxalate production. The most severe form, PH1, is caused by a mutation in alanine-glyoxylate aminotransferase gene which leads to progression to end-stage kidney disease by age of 60 years in 88% of patients [1, 2]. We present a case of a 25-year-old woman with chronic kidney disease secondary to PH1, diagnosed at the age of three when she presented with nephrolithiasis. The genetic analysis detected two mutations in the homozygous state in an AGTX gene: AGTX NM_000030.3:c.33dupC, p.(Lys12FInfs*156). Her parents were not blood relatives. She underwent multiple lithotripsies for the treatment of nephrolithiasis but was not in regular follow-ups due to noncompliance. In March 2020, she presented at the Emergency Department Unit in the terminal stage of kidney failure with the need for hemodialysis. The chronic hemodialysis protocol included four sessions weekly lasting for 4.5 h. Her menstrual cycles were irregular. On September 13, 2022, she reported amenorrhea. A gynecological workup revealed that she was approximately 24 weeks pregnant. She did not undergo genetic counseling before conception nor received any new medications. The hemodialysis program was intensified to five sessions per week, increasing dialysis time to 5 h. A Theranova 400 membrane (Baxter) was used and a dialysate bath was adjusted depending on laboratory results. Nadroparin was administered as an anticoagulant agent at a dose of 0.4 mL per session. She received paricalcitol, vitamin B6 3 50 mg, folic acid, pantoprazole 20 mg, and an oral nutritional supplement. Predialysis urea levels were maintained below 12.5 mmol/L. We also aimed to maintain normal calcium levels and hemoglobin concentration at approximately 110 g/L. Her dry weight was increased by 500 mg every 7 days corresponding to an increase in weight during normal pregnancies. The patient was hospitalized at 37 weeks of gestation and gave birth to a healthy 2450-g male baby 2 days later by Cesarean section. The postpartum course was uneventful. Her regular hemodialysis has been continued four times weekly. She is waiting for simultaneous liver–kidney transplantation and the approval of the use of lumasiran, with the skin ulcer on her leg indicating systemic oxalosis. Current treatment options for PH1 are limited. Simultaneous liver–kidney transplantation is used for patients with end-stage kidney failure [2]. Lumasiran is a novel liver-directed RNA interference therapeutic agent. It reduces hepatic oxalate production and increases concentrations of glycolate in patients with PH1, by degrading the messenger RNA that encodes glycolate oxidase, an enzyme upstream of alanineglyoxylate a","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758457","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}
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