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。
{"title":"Effect of Ramadan fasting on chronic inflammation markers and gut bacterial endotoxins among Egyptian hemodialysis patients.","authors":"Emad Samaan, Ahmed A Eldeeb, Ahmed B Ibrahim, Mohammed Erman, Alaa A Sabry, Mostafa A Mahmoud","doi":"10.1111/1744-9987.13988","DOIUrl":"https://doi.org/10.1111/1744-9987.13988","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>A beneficial effect of Ramadan fasting on levels of bacterial endotoxins and markers of chronic inflammation in hemodialysis patients was observed.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"655-660"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741240","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}
Background: The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population.
Methods: GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up.
Results: GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality.
Conclusion: The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.
{"title":"The association between geriatric nutritional risk index variability and mortality in peritoneal dialysis patients.","authors":"Filiz Yıldırım, Ozcan Uzun, Guler Nasuhbeyoglu, Aslihan Narlioglu, Yelda Deligöz Bildacı, Caner Cavdar, Serpil Muge Deger","doi":"10.1111/1744-9987.13984","DOIUrl":"https://doi.org/10.1111/1744-9987.13984","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to examine the association between the Geriatric Nutritional Risk Index (GNRI) and overall mortality in this population.</p><p><strong>Methods: </strong>GNRI values were calculated by using the serum albumin levels and body weight and the GNRI variability reflects the changes in GNRI change slopes in the follow-up.</p><p><strong>Results: </strong>GNRI values showed a decrease from the median baseline GNRI of 106.3 (IQR, 95.0,113.4) to 98.4 (interquartile range [IQR], 91.9108.9) (p < 0.001). The median GNRI variability was 4.7 (IQR, 2.5, 10.3). Both baseline GNRI levels (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93, 0.99, p = 0.04) and more profoundly GNRI variability (adjusted OR: 1.23, 95% CI: 1.01, 1.44, p = 0.03) were independently associated with mortality.</p><p><strong>Conclusion: </strong>The monitorization of the changes in GNRI values as a variability index is an easy tool that might improve the predictive accuracy of mortality in peritoneal dialysis patients.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"752-759"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797393","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, 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":"27 4","pages":"821-822"},"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}
Francesco Sbrana, Beatrice Dal Pino, Tiziana Sampietro
Dear Editor, Lipoprotein apheresis (LA) is the therapeutic “last chance saloon” for inherited dyslipidemias resistant/intolerant to lipid lowering drugs [1]. High plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness, phenomenon that can be acutely “restored,” by LA [2]. That is why heterozygous Familial Hypercholesterolemia (HeFH) patients under LA care are a good clinical model to study the effects of cholesterol modulation on the endothelial function. Aim of this pilot study was to evaluate, in patients with HeFH and ischemic heart disease, the impact of a single LA on skin microcirculation evaluated by Doppler flowmetry. We enrolled 8 male HeFH (mean age 59 ± 8 years), without relevant comorbidity; written informed consent was obtained from all patients and our procedures adhered to the Declaration of Helsinki. All patients are on chronic LA treatment because, despite the maximal lipid lowering therapies (atorvastatin/ezetimibe 20/10 mg daily), do not archives the target lipid levels. LA treatments were performed according manufacturer's instructions (1.5–2.5 plasma volume patient/session) by dextran-sulfate absorption from plasma (Liposorber-LA MA-03 systems; Kaneka, Osaka, Japan). To evaluate the effect of LA treatment on skin microcirculation, laser Doppler flowmetry was performed before LA, immediately after LA, at Days 2 and 6 after the treatment. Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux PF4001 Master, Perimed, Sweden) on the left index toe and a thermostatic probe (PF 4005, Perimed, Sweden) was placed on the distal phalanx. The perfusion measured, in arbitrary perfusion units (PU), was evaluated baseline (39 C) and after heated (44 C). Skin blood flow significantly improves after heated in all the evaluations time. Moreover, skin blood flow was evaluated in a control group matched for age and sex. The LA treatment significantly improve atherogenic lipid profile (total cholesterol 74%, Low Density Lipoprotein LDL cholesterol 83%, triglycerides 59%, Apo B lipoprotein 79%, Lp(a) 88%; p < 0.05; High Density
{"title":"Skin microcirculation significantly increases after lipoprotein apheresis.","authors":"Francesco Sbrana, Beatrice Dal Pino, Tiziana Sampietro","doi":"10.1111/1744-9987.13976","DOIUrl":"https://doi.org/10.1111/1744-9987.13976","url":null,"abstract":"Dear Editor, Lipoprotein apheresis (LA) is the therapeutic “last chance saloon” for inherited dyslipidemias resistant/intolerant to lipid lowering drugs [1]. High plasma cholesterol per se may be a sufficient stimulus to upregulate endothelial adhesiveness, phenomenon that can be acutely “restored,” by LA [2]. That is why heterozygous Familial Hypercholesterolemia (HeFH) patients under LA care are a good clinical model to study the effects of cholesterol modulation on the endothelial function. Aim of this pilot study was to evaluate, in patients with HeFH and ischemic heart disease, the impact of a single LA on skin microcirculation evaluated by Doppler flowmetry. We enrolled 8 male HeFH (mean age 59 ± 8 years), without relevant comorbidity; written informed consent was obtained from all patients and our procedures adhered to the Declaration of Helsinki. All patients are on chronic LA treatment because, despite the maximal lipid lowering therapies (atorvastatin/ezetimibe 20/10 mg daily), do not archives the target lipid levels. LA treatments were performed according manufacturer's instructions (1.5–2.5 plasma volume patient/session) by dextran-sulfate absorption from plasma (Liposorber-LA MA-03 systems; Kaneka, Osaka, Japan). To evaluate the effect of LA treatment on skin microcirculation, laser Doppler flowmetry was performed before LA, immediately after LA, at Days 2 and 6 after the treatment. Skin blood flow was measured using PeriFlux laser Doppler flowmetry (Periflux PF4001 Master, Perimed, Sweden) on the left index toe and a thermostatic probe (PF 4005, Perimed, Sweden) was placed on the distal phalanx. The perfusion measured, in arbitrary perfusion units (PU), was evaluated baseline (39 C) and after heated (44 C). Skin blood flow significantly improves after heated in all the evaluations time. Moreover, skin blood flow was evaluated in a control group matched for age and sex. The LA treatment significantly improve atherogenic lipid profile (total cholesterol 74%, Low Density Lipoprotein LDL cholesterol 83%, triglycerides 59%, Apo B lipoprotein 79%, Lp(a) 88%; p < 0.05; High Density","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"823-824"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134476","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}
Murat Aslan, Rabia Yılmaz, Murat Doğan, Zafer Çukurova
Introduction: Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.
Methods: The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022.
Results: The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035).
Conclusion: TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.
{"title":"The effect of therapeutic plasma exchange therapy on veno-venous ECMO weaning success in severe COVID-19 ARDS patients.","authors":"Murat Aslan, Rabia Yılmaz, Murat Doğan, Zafer Çukurova","doi":"10.1111/1744-9987.13979","DOIUrl":"https://doi.org/10.1111/1744-9987.13979","url":null,"abstract":"<p><strong>Introduction: </strong>Primarily, this study aimed to investigate the effect of TPE (therapeutic plasma exchange) treatment on successful ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.</p><p><strong>Methods: </strong>The study was applied retrospectively on patients over the age of 18 who were hospitalized in the ICU between January 1, 2020 and March 1, 2022.</p><p><strong>Results: </strong>The study was performed on 33 patients, 36.3% (n: 12) of whom received TPE treatment. The rate of successful ECMO weaning was statistically higher in the TPE treatment group (without TPE: 14.3% [n: 3], with TPE: 50% [n: 6], p = 0.044). The 1-month mortality was also statistically lower in the TPE treatment group (p = 0.044). In the logistic analysis, It was found that the risk of unsuccessful ECMO weaning increased 6 times in those who did not receive TPE treatment (OR; 6.0, 95% CI; 1.134-31.735, p = 0.035).</p><p><strong>Conclusion: </strong>TPE treatment may increase the success rate of V-V ECMO weaning in severe COVID-19 ARDS patients treated with V-V ECMO.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"780-789"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9732772","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":"Immunocompromised states caused the prolonged duration of viral shedding in middle-aged and elderly hemodialysis patients infected with the Omicron variant of COVID-19.","authors":"Xianwen Zhang, Linli Zhang, Kun Zhang, Yiping Chen, Lin Wang","doi":"10.1111/1744-9987.13969","DOIUrl":"10.1111/1744-9987.13969","url":null,"abstract":"To evaluate the impact of hemodialysis on the duration of viral shedding in middle‐aged and elderly patients with the Omicron variant of COVID‐19.","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"720-725"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101090","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}
Introduction: Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic.
Methods: We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022.
Results: The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality.
Conclusions: COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.
{"title":"The predictive markers of severity and mortality in hospitalized hemodialysis patients with COVID-19 during Omicron epidemic.","authors":"Masataka Banshodani, Hideki Kawanishi, Takayuki Hirai, Yusuke Kawai, Shinji Hashimoto, Sadanori Shintaku, Misaki Moriishi, Seiji Marubayashi, Shinichiro Tsuchiya","doi":"10.1111/1744-9987.13970","DOIUrl":"https://doi.org/10.1111/1744-9987.13970","url":null,"abstract":"<p><strong>Introduction: </strong>Predictive markers and prognosis remain unclear in hospitalized hemodialysis (HD) patients with coronavirus disease 2019 (COVID-19) during the Omicron epidemic.</p><p><strong>Methods: </strong>We evaluated characteristics, laboratory parameters, and outcomes in hospitalized HD patients with COVID-19 (n = 102) at two centers between January and April 2022.</p><p><strong>Results: </strong>The 30-day mortality rate was higher in moderate-critical group (n = 43) than mild group (n = 59) (16.3% vs. 1.7%; p = 0.007), and higher in patients with lower CC chemokine ligand 17 (CCL17) levels (<95.0 pg/mL) compared with normal CCL17 levels (19.0% versus 4.9%; p = 0.03). In multivariate analyses, a low CCL17 level (p = 0.003) was associated with moderate-critical conditions, and moderate-critical conditions (p = 0.04) were associated with 30-day mortality, whereas CCL17 was not associated with 30-day mortality.</p><p><strong>Conclusions: </strong>COVID-19 remains a fatal complication, and CCL17 was a predictive marker of severity in hospitalized HD patients during the Omicron epidemic.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"701-710"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10101093","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}
Objective: To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients.
Methods: Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded.
Results: The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001).
Conclusion: Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.
{"title":"Effect of ticagrelor on the function of tunneled cuffed catheter in maintenance hemodialysis patients.","authors":"Jianming Shen, Yanyan Deng, Liping Wang, Fei Zha","doi":"10.1111/1744-9987.13980","DOIUrl":"https://doi.org/10.1111/1744-9987.13980","url":null,"abstract":"<p><strong>Objective: </strong>To observe the effect of ticagrelor on the function of a tunneled cuffed catheter (TCC) in maintenance hemodialysis (MHD) patients.</p><p><strong>Methods: </strong>Eighty MHD patients (control group: 39 cases, observation group: 41 cases) using TCC as vascular access were enrolled from January 2019 to October 2020 in this prospective study. Patients in the control group were routinely treated with aspirin for antiplatelet therapy, while patients in the observation group were treated with ticagrelor. The catheter life time, catheter dysfunction, coagulation function, and antiplatelet drug-related adverse events of the two groups were recorded.</p><p><strong>Results: </strong>The median life time of TCC in the control group was significantly higher than that in the observation group. Moreover, the log rank test showed that the difference was statistically significant (p < 0.001).</p><p><strong>Conclusion: </strong>Ticagrelor may reduce the incidence of catheter dysfunction and prolong the life time of the catheter by preventing and reducing the thrombosis of TCC in MHD patients, without obvious side effects.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"694-700"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742509","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}
İbrahim Ethem Pınar, Vildan Özkocaman, Tuba Ersal, Mehmet Emin Dağtekin, Cumali Yalçın, Bedrettin Orhan, Ömer Candar, Sinem Çubukçu, Tuba Güllü Koca, Vildan Gürsoy, Fahir Özkalemkaş
Introduction: Our study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.
Methods: This retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).
Results: There was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.
Conclusion: The study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.
{"title":"The effect of the time from diagnosis to induction therapy on prognosis in patients with acute leukemia undergoing leukapheresis for symptomatic hyperleukocytosis.","authors":"İbrahim Ethem Pınar, Vildan Özkocaman, Tuba Ersal, Mehmet Emin Dağtekin, Cumali Yalçın, Bedrettin Orhan, Ömer Candar, Sinem Çubukçu, Tuba Güllü Koca, Vildan Gürsoy, Fahir Özkalemkaş","doi":"10.1111/1744-9987.13990","DOIUrl":"https://doi.org/10.1111/1744-9987.13990","url":null,"abstract":"<p><strong>Introduction: </strong>Our study investigated leukapheresis's effect on delayed induction therapy outcomes in patients with acute leukemia presenting with symptomatic hyperleukocytosis.</p><p><strong>Methods: </strong>This retrospective cohort study included 30 adult patients diagnosed with acute leukemia who underwent leukapheresis for leukostasis. The patients were divided into the first 24 h and >24 h groups, according to the time from diagnosis to induction therapy (TDT).</p><p><strong>Results: </strong>There was no significant difference between the TDT groups regarding complete remission (CR), 4-week mortality, and overall survival (OS) at a median follow-up of 409 days. Tumor lysis syndrome, disseminated intravascular coagulation, and hemoglobin levels were significant in early mortality. In univariate analysis, age, hemoglobin levels, patients' eligibility for intensive chemotherapy, and achieving CR were critical factors for OS.</p><p><strong>Conclusion: </strong>The study findings suggest that waiting for the clinical and laboratory results may be a safe and reasonable approach before assigning patients the best treatment option with leukapheresis.</p>","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"802-812"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9742530","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, In chronic kidney disease–mineral and bone disorder (CKD–MBD), monitoring blood biochemical parameters is recommended, and albumin-corrected total serum calcium concentration (cCa) is generally used as a parameter of blood calcium [1]. However, several factors in the blood make cCa unreliable to indicate the physiological activity of blood calcium. We found six maintenance hemodialysis (MHD) patients who had hypocalcemia of cCa <8.4 mg/dL repeatedly while having plasma intact parathyroid hormone concentration (iPTH) not over the recommended range [2]. For them, calcimimetics and vitamin D analogues had not been administered. Since cCa might not have indicated the physiological activity of blood calcium, correlations between cCa, plasma ionized calcium concentration (iCa), and iPTH were examined in them. Correlations were analyzed by Pearson's correlation test in the SPSS software package (IBM Corp., Armonk, NY). Table 1 shows the characteristics and biochemical parameters of the patients. The age and dialysis vintage ranged 59–75 years and 6–92 months, respectively. Calcium bicarbonate was administered to five patients, and lanthanum bicarbonate was also administered to two of them. In one, three, and two patients, iPTH (normal range [NR]: 10–65 pg/mL) was 10–65, 65–130 and 130–260 pg/mL, respectively. In the simultaneous measurement, cCa (NR: 8.4–10.1 mg/dL), iP (NR: 3.5–5.5 mg/dL), and iCa (NR: 1.16–1.30 mmol/L) ranged 7.04–8.22 mg/dL, 3.4–7.2 mg/dL, and 0.89–1.11 mmol/L, respectively. While cCa and iCa correlated with each other (r = 0.90, p = 0.016), neither cCa nor iCa correlated with iPTH significantly (p = 0.14 and 0.09, respectively). The positive correlation between cCa and iCa suggests that cCa could indicate the physiological activity of blood calcium and be a parameter of CKD–MBD in them. While two patients had hyperphosphatemia of >5.5 mg/dL, hyperphosphatemia is an iPTH-elevating factor and would not have influenced the finding of iPTH not over the recommended range in them [3]. Thus, the finding suggests that some HD patients have iPTH not over the recommended range under hypocalcemia. The iPTH not over the recommended range under hypocalcemia would be resulted from a shift of the serum-calcium-sensing set point to a hypocalcemic state in their parathyroid. Since MHD patients with chronic hypocalcemia will have a steeper iCa increase during each dialysis session compared
{"title":"Possible parathyroid calcium-sensing set point shift in patients undergoing maintenance hemodialysis.","authors":"Masayuki Tanemoto, Takahiro Kasai, Yoshito Iida","doi":"10.1111/1744-9987.13982","DOIUrl":"https://doi.org/10.1111/1744-9987.13982","url":null,"abstract":"Dear Editor, In chronic kidney disease–mineral and bone disorder (CKD–MBD), monitoring blood biochemical parameters is recommended, and albumin-corrected total serum calcium concentration (cCa) is generally used as a parameter of blood calcium [1]. However, several factors in the blood make cCa unreliable to indicate the physiological activity of blood calcium. We found six maintenance hemodialysis (MHD) patients who had hypocalcemia of cCa <8.4 mg/dL repeatedly while having plasma intact parathyroid hormone concentration (iPTH) not over the recommended range [2]. For them, calcimimetics and vitamin D analogues had not been administered. Since cCa might not have indicated the physiological activity of blood calcium, correlations between cCa, plasma ionized calcium concentration (iCa), and iPTH were examined in them. Correlations were analyzed by Pearson's correlation test in the SPSS software package (IBM Corp., Armonk, NY). Table 1 shows the characteristics and biochemical parameters of the patients. The age and dialysis vintage ranged 59–75 years and 6–92 months, respectively. Calcium bicarbonate was administered to five patients, and lanthanum bicarbonate was also administered to two of them. In one, three, and two patients, iPTH (normal range [NR]: 10–65 pg/mL) was 10–65, 65–130 and 130–260 pg/mL, respectively. In the simultaneous measurement, cCa (NR: 8.4–10.1 mg/dL), iP (NR: 3.5–5.5 mg/dL), and iCa (NR: 1.16–1.30 mmol/L) ranged 7.04–8.22 mg/dL, 3.4–7.2 mg/dL, and 0.89–1.11 mmol/L, respectively. While cCa and iCa correlated with each other (r = 0.90, p = 0.016), neither cCa nor iCa correlated with iPTH significantly (p = 0.14 and 0.09, respectively). The positive correlation between cCa and iCa suggests that cCa could indicate the physiological activity of blood calcium and be a parameter of CKD–MBD in them. While two patients had hyperphosphatemia of >5.5 mg/dL, hyperphosphatemia is an iPTH-elevating factor and would not have influenced the finding of iPTH not over the recommended range in them [3]. Thus, the finding suggests that some HD patients have iPTH not over the recommended range under hypocalcemia. The iPTH not over the recommended range under hypocalcemia would be resulted from a shift of the serum-calcium-sensing set point to a hypocalcemic state in their parathyroid. Since MHD patients with chronic hypocalcemia will have a steeper iCa increase during each dialysis session compared","PeriodicalId":23021,"journal":{"name":"Therapeutic Apheresis and Dialysis","volume":"27 4","pages":"815-816"},"PeriodicalIF":1.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134486","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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