Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy最新文献

Introduction: Adult-onset IgA vasculitis (IgAV) often presents with severe renal and gastrointestinal (GI) complications, yet therapeutic guidelines for life-threatening manifestations remain unclear.

Methods: We conducted a systematic text-mining analysis of all PubMed-indexed case reports of IgAV treated with therapeutic plasma exchange (TPE).

Results: We describe an 80-year-old woman with refractory GI bleeding and rapidly progressive glomerulonephritis. Despite high-dose corticosteroids and cyclophosphamide, GI bleeding persisted and necessitated multiple transcatheter embolization. A total of seven sessions of TPE using fresh frozen plasma successfully controlled disease activity, resulting in improvement of GI bleeding. Literature review suggests that TPE may provide additive benefits in IgAV patients, particularly in those unresponsive to standard immunosuppressants.

Conclusion: This case supports the utility of TPE as a valuable adjunctive therapy in severe IgAV with organ-threatening manifestations and highlights the need for further studies to define optimal indications.

Introduction: This study aimed to investigate the factors associated with hospitalization in older patients with pre-dialysis CKD, including physical function.

Methods: This single-center, prospective cohort study included 111 patients aged ≥65 years with stage 3-5 non-hemodialyzed CKD. Physical function was assessed using the short physical performance battery (SPPB), 10-m walk test, and grip strength test. Hospitalizations and reasons for readmission were tracked from discharge to the end of the follow-up period.

Results: Kaplan-Meier analysis showed significant associations between rehospitalization and SPPB, 10-meter walk speed, and grip strength. The cutoff values predicting rehospitalization were 11 points for SPPB, 1.1 m/s for 10-meter walk speed, and 31 kg for grip strength. Multivariate Cox regression revealed that SPPB, hemoglobin, and estimated glomerular filtration rate (eGFR) were independently associated with rehospitalization risk.

Conclusions: SPPB may predict hospitalization in older pre-dialysis CKD patients, emphasizing the importance of screening and preventing physical function decline.

Introduction: Ferritin to albumin ratio (FAR) is a combined marker for inflammation and nutritional status. This study aims to investigate FAR and its relationship with mortality in peritoneal dialysis (PD) patients.

Methods: One hundred seventy-seven PD patients were enrolled in this retrospective study. Prevalence of all-cause mortality and associated factors were analyzed.

Results: Patients were divided into two groups according to mortality status. While patients were older and the presence of diabetes mellitus was more common in the mortality group, urine volume and normalized protein catabolic rate (nPCR) were higher in nonmortality patients. The mortality group had higher levels of FAR (p = 0.001). We further analyzed patients according to FAR levels. The 75th percentile of FAR was defined as the high FAR (> 143.4) group, and in the Kaplan-Meier Survival Analysis, the low FAR group had better survival than the high FAR group (p = 0.011). FAR was positively correlated with age and C-reactive protein (CRP) and negatively correlated with urine volume. Cox regression analysis revealed that age (p < 0.001), FAR (p = 0.008), nPCR (p = 0.002), and urine volume (p = 0.039) were independent predictors of all-cause mortality.

Conclusion: The present study demonstrates that FAR is an independent predictor of all-cause mortality among PD patients.

Introduction: Rheocarna has attracted attention as an alternative therapy for severe chronic limb-threatening ischemia, and there have been reports of its usefulness. However, most of these reports have been on dialysis patients, and there are few reports on the treatment conditions and efficacy in non-dialysis patients.

Methods: Four non-dialysis patients who received Rheocarna were studied to determine the conditions under which it was administered and its effectiveness.

Results: The ulcer healed completely, but two patients required skin grafting. The treatment time and blood flow rate were 90-120 min and 50-80 mL/min, respectively. The processed volume was about 1.0 times the circulating blood volume, and the removal rate of low-density lipoprotein and fibrinogen was about 10%-15%.

Conclusion: The ulcers healed despite the removal rate of low-density lipoprotein and fibrinogen being small. To our knowledge, this is the first report on the treatment conditions and effectiveness of Rheocarna in non-dialysis patients.

Introduction: This single-center retrospective study investigated the clinical effects of combination therapy involving continuous renal replacement therapy (CRRT) and continuous intravenous sodium infusion therapy (cIVNa) in critically ill patients with prerenal acute kidney injury (AKI) who were expected to experience insufficient plasma refilling.

Method: The clinical data of 92 patients were analyzed. Clinical data from the control (CRRT, n = 49) and intervention (CRRT + cIVNa, n = 43) groups were compared statistically.

Results: Combination therapy increased blood pressure and urine volume, while reducing hypotension events, indicating hemodynamic stabilization. Furthermore, it significantly improved the 90-day survival rate (61.9% vs. 38.8%, p < 0.05), 60-day and 90-day survival rates without RRT (59.5% vs. 28.6%, p < 0.01; 54.8% vs. 26.5%, p < 0.01, respectively), survival discharge rate from intensive care unit, CRRT withdrawal rate, and renal replacement therapy withdrawal rate.

Conclusion: Combination therapy with continuous renal replacement therapy and continuous intravenous sodium infusion therapy may be a useful treatment option for critically ill patients with prerenal acute kidney injury who require continuous renal replacement therapy.

The increasing incidence of renal failure, driven by chronic kidney disease and other chronic conditions, has led to a rising prevalence of end-stage renal disease (ESRD). Maintenance hemodialysis (MHD) is the primary renal replacement therapy for ESRD and requires lifelong treatment. This ongoing therapy not only causes substantial physical discomfort but also imposes considerable psychological and emotional stress on patients and their families, affecting their overall mental health. The concept of "dyadic coping", introduced by Bodenmann, treats partners as a single unit in their joint management of stress and proposes "dyadic coping interventions" to enhance coping strategies and relational dynamics. These interventions have been shown to reduce psychological distress and perceived caregiving burden, thereby improving caregiving efficacy. Recent studies have demonstrated the effectiveness of dyadic coping interventions in home care settings for patients undergoing hemodialysis and their caregivers, showing improvements in both disease burden and quality of life. This review aims to explore the application of dyadic coping interventions in hemodialysis settings, presenting new strategies for enhancing the quality of life for both patients and their caregivers.

Introduction: This article aimed to explore the needs status of patients undergoing automated peritoneal dialysis (APD) based on the behavior change wheel (BCW) theory (and associated improvement strategies) to clarify the obstacles that affect patients' behavior choices. Furthermore, it aimed to explore practical countermeasures to improve the quality of life of patients undergoing APD.

Methods: Eleven patients undergoing APD were selected for a semi-structured in-depth interview using the purposive sampling method, and the phenomenological qualitative research method was used to organize and analyze the content of the interviews and to consider reasonable interventions under the guidance of the BCW theory.

Results: The study identified three themes and six sub-themes that guide patients on peritoneal dialysis to choose APD as a behavior change: opportunity needs (a desire to diversify access to information and patients' desire to try APD if physically possible); motivation needs (a desire to better fulfill family responsibilities and a desire to return to society); and capability needs (a desire to have some social skills and a desire to have self-management capability).

Conclusion: Medical staff should design personalized intervention strategies according to patients' abilities, opportunities and motivation needs, including optimizing information transmission, improving technical support, promoting patient health management efficiency and improving the acceptance of APD through social support and publicity, to improve patients' quality of life.

Aim: This study was conducted to evaluate the sense of humor, treatment compliance, and personal well-being levels of patients receiving hemodialysis (HD) treatment.

Materials and methods: The research was conducted with 131 patients who received HD treatment in two different HD Units in the south of Turkey and agreed to participate in the research. Data were collected using the Personal Information Form, Multidimensional Sense of Humor Scale (MSHS), End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), and Personal Well-Being Index-Adult (PWI-A).

Results: The mean MSHS score of the individuals was 62.511 ± 12.241, the mean ESRD-AQ score was 896.64 ± 109.89, and the mean PWI-A score was 37.03 ± 9.64. When the relationships between the age of the patients, duration of HD, and MSHS, ESRD-AQ, and PWI-A are examined, there is a statistically significant negative relationship between age and MSHS and PWI-A. There is no statistically significant relationship between MSHS, ESRD-AQ, and PWI-A. The mean PWI-A scores of those who live separately from their spouses, have an income less than their expenses, have another chronic disease, and receive dialysis four times a week; the mean ESRD-AQ scores of those who receive dialysis four times a week and smoke; and the mean MSHS scores of those who are illiterate, have an income less than their expenses, receive dialysis four times a week, and do not smoke were found to be statistically significantly lower.

Conclusion: It is seen that patients receiving HD treatment have a moderate sense of humor, high treatment compliance, and low personal well-being. Sense of humor and personal well-being levels decreased with increasing age, while there was no significant relationship between sense of humor, compliance with treatment, and personal well-being levels. While high compliance with treatment suggests that they have insight, it is recommended that a sense of humor and personal well-being be supported, and counseling services be provided to patients.