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: Autoimmune neurological diseases (ANDs) involve the immune system attacking the nervous system, leading to various symptoms. Therapeutic plasma exchange (TPE) is used to remove pathogenic autoantibodies, aiming to improve clinical outcomes.

Methods: This ambispective observational study included 99 patients with ANDs who underwent TPE from January 2018 to June 2022 at a tertiary care center in India. Clinical outcomes were measured using the modified Rankin Scale (mRS) scores at admission, post-TPE, at 3-months, 6-months, and 1-year follow-up post-discharge. Data were analyzed using Epi Info version 7.0.

Results: The median mRS score improved significantly from 5 (IQR 4-5) before TPE to 3 (IQR 2-4) post-TPE (p < 0.001). Complications occurred in 5.95% of procedures, with allergic reactions being the most common. The in-hospital mortality rate was 9%.

Conclusion: TPE is a safe and effective treatment modality for autoimmune neurological diseases, especially in resource-constrained settings. It aids in both symptomatic relief and reducing long-term functional disability.

Introduction: Hemodialysis patients' adherence to hemodialysis sessions, medication, diet and, fluid restriction is an essential condition to ensure effective treatment. Therefore, this study aimed to assess the overall adherence of hemodialysis patients in the Marrakech-Safi region of Morocco.

Methods: A quantitative cross-sectional study of hemodialysis patients at the Safi, Youssoufia and Ibn Tofail public hemodialysis centers was conducted in the last trimester of 2023 using a questionnaire (ESRD-AQ), which was completed by analyzing patient records and interviewing patients during the hemodialysis session.

Results: A total of 199 patients were included in this study. Women accounted for 53.3% of patients, 73.9% were under 65 years, 55.8% had been on hemodialysis for more than 5 years, and 62.8% had an Inter-dialytic-weight (IDW) ≥ 2.5 kg. Mean scores for adherence to hemodialysis, medication, diet and fluid restriction were 534.92 ± 98.71 out of 600, 113.32 ± 50.86 out of 200, 75.38 ± 42.00 out of 200 and 52.51 ± 53.59 out of 200, respectively. Regarding overall adherence, 24.1% had low adherence, 63.8% had moderate adherence, and 12.1% had good adherence, with a mean score of 793.99 ± 151.28 out of 1200. Our results showed that male gender (p = 0.010, ORa = 5.61), young age (p = 0.004, ORa = 8.48), and short duration on hemodialysis (p = 0.001, ORa = 23.91) were risk factors for low overall adherence.

Conclusion: Our results justify the increased need for educational programs aimed at improving the overall adherence of hemodialysis patients.

Introduction: Ferritin level and erythropoiesis-stimulating agent (ESA) responsiveness are each associated with hemodialysis patient survival. We assessed interrelationships between these two vs. survival.

Methods: Patients in the Japan Dialysis Outcomes and Practice Patterns Study Phases 4-6 (2009-2018) were included. All-cause mortality associations were assessed with progressive adjustment to evaluate covariate influence.

Results: During follow-up (median 2.6 years), 773 of 5154 patients died. After covariate adjustment, the mortality hazard ratio (HR) was 0.99 (95% CI: 0.81, 1.20) for low serum ferritin and 1.12 (CI: 0.89, 1.41) for high serum ferritin. By contrast, mortality risk with elevated ESA resistance index (ERI) persisted after covariate adjustment (HR 1.44, CI [1.17-1.78]). The serum ferritin and ERI interaction was not significant; p > 0.96 across all models.

Conclusions: Japanese hemodialysis patients with high ERI experienced worse survival independent of serum ferritin levels, highlighting the importance of identifying and mitigating ESA hyporesponsiveness among dialysis patients.

Introduction: Fatigue is reportedly associated with a poor prognosis in dialysis patients. The aim of the present study was to investigate whether fatigue on dialysis days or non-dialysis days is associated with mortality in patients on chronic hemodialysis.

Methods: This was a prospective study of 134 hemodialysis patients. The level of fatigue was evaluated using a visual analog scale (VAS). The association between high fatigue evaluated by the highest quartile of the VAS value and all-cause death was investigated.

Results: The fatigue scale score was significantly higher on dialysis than on non-dialysis days. During the follow-up period (median 6.8 years), 42 patients died. Patients with high post-dialysis fatigue in the higher quartiles died more frequently compared to those with in the lower quartiles (p = 0.012). Multivariate Cox regression analysis showed that high post-dialysis fatigue was an independent predictor of all-cause death (adjusted hazard ratio 2.12, 95% confidence interval 1.10-4.07).

Conclusion: Higher post-dialysis fatigue is related to increased mortality.

Introduction: The mortality impact of peritoneal dialysis (PD) and hemodialysis (HD) in end-stage renal disease (ESRD) remains uncertain.

Methods: A meta-analysis comparing mortality in ESRD patients on PD versus HD was conducted, including 9 studies with 7556 HD and 2651 PD patients.

Results: No significant difference was found in all-cause mortality, cardiovascular-related mortality, or infection-related mortality between HD and PD patients. Hemoglobin, ferritin, and iron levels were similar in groups, but HD patients had higher albumin and BUN levels (p < 0.05). Regarding cardiovascular factors and bone minerals, total cholesterol and LDL levels were significantly lower, and calcium levels were significantly higher in the HD group compared with the PD group (p < 0.01).

Conclusion: Mortality does not significantly differ between HD and PD in ESRD patients, though HD is linked to higher serum albumin levels and lower levels of total cholesterol and LDL.

Introduction: We aimed to evaluate the characteristics of the patients with a rheumatologic disease who underwent TPE.

Method: A single-center, retrospective study was conducted between January 2016 and June 2023.

Results: Twenty patients with a median age of 51 years received a median of 6 TPE sessions. Concurrently, immunosuppressive therapy was administered to 18 (90%) of them. During the follow-up period, 9 patients (45%) died. Creatinine (p = 0.001), C-reactive protein (p = 0.001), sedimentation rate (p = 0.002), leukocyte (p = 0.003), thrombocyte (p = 0.003), and neutrophil (p = 0.003) counts was decreased after TPE. Similarly, in the ROC analysis of post TPE laboratory parameters, urea, creatinine, CRP, hemoglobin, platelets, and lymphocytes predicted mortality with areas under the curve values ranging from 0.747 to 0.869. In the Cox regression analysis for mortality, creatinine was predictive for mortality (p = 0.030), HR 1.59 (95% CI: 1.05-2.41).

Conclusion: In rheumatologic conditions, TPE is beneficial to fill the gap until the effects of immunosuppressants become apparent.

Introduction: Hybrid dialysis is widely used in Japan. Although previous reports have shown the beneficial effects of hybrid dialysis, little is known about the daily change in peritoneal ultrafiltration volume in hybrid dialysis.

Methods: A multicenter, cross-sectional study was conducted in 25 patients with hybrid dialysis. The primary outcome measure was the change in peritoneal ultrafiltration volume between after HD and before HD, according to PD prescription and PD holiday. The secondary outcome measure was the correlation between the difference in ultrafiltration volume and each factor.

Results: The total ultrafiltration volume and the ultrafiltration volume of glucose dialysate after HD increased from 970 ± 408 to 1151 ± 480 (p < 0.01) and from 576 ± 392 to 750 ± 517 (p < 0.01), respectively, compared with before HD. In contrast, the ultrafiltration volume of icodextrin dialysate did not change (from 470 ± 204 to 494 ± 242, p = 0.40). The difference in total ultrafiltration volume was correlated with the difference in glucose dialysate ultrafiltration volume and hybrid duration, but not with the difference in icodextrin dialysate ultrafiltration volume and peritoneal dialysis duration.

Conclusion: This study showed that the peritoneal ultrafiltration volume for glucose dialysate increased after HD compared with before HD in patients with hybrid dialysis, whereas that for icodextrin dialysate did not change.