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

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to significant morbidity and mortality worldwide, with acute kidney injury (AKI) emerging as a significant non-pulmonary complication of COVID-19. This study aimed to evaluate the effect of hemodialysis (HD) membrane type on the outcomes of COVID-19 patients with AKI requiring dialysis.

Methods: A retrospective analysis was conducted on 82 COVID-19 patients with AKI who required HD between January 2020 and January 2022. Patients were categorized based on the type of dialysis membrane used as medium cut-off (MCO) versus low-flux (LF). Demographic data, clinical characteristics, laboratory findings, and hospital outcomes, including 28-day mortality, were analyzed.

Results: The mean age of the study population was 69.7 ± 11.6 years, with 45% being female. The median time to HD initiation was shorter in the LF group (p < 0.001). Although ICU admission rates were similar between the groups, the 28-day mortality rate was significantly lower in the MCO group (p = 0.03). Multivariate analysis identified ICU admission as an independent risk factor for mortality while using MCO membranes, associated with a reduced mortality risk (OR: 0.344, p = 0.03). MCO membrane was significantly associated with a higher 28-day survival rate by Kaplan-Meier curve analysis with log-rank test (56.8% vs. 33.3%, p = 0.001).

Conclusions: The findings suggest that using MCO membranes in HD may improve survival outcomes in COVID-19 patients with AKI. Further prospective studies are needed to validate these results and elucidate the potential anti-inflammatory benefits of MCO membranes in this patient population.

Introduction: To date, despite the new lipid-lowering drugs, some subjects do not reach LDL-cholesterol and/or lipoprotein(a) [Lp(a)] goals and lipoprotein apheresis (LA) plays a role in atherosclerosis prevention.

Methods: The aim of this study is to paint a portrait of the current LA activity in Italy, collecting data via an electronic survey.

Results: Forty-seven centers were contacted, data from 142 patients (male 67%) were obtained from 15 sites. Two sites had discontinued LA treatment. In the active sites, a median of 17 [14-26] LA treatment/patient per year was performed; 7/13 sites used more than one LA system, with venous vascular access used in 87% of cases. High Lp(a) plasma concentrations (> 60 mg/dL or ≥ 145 nmol/L) were recorded in 73/142 patients; 14/36 homozygous familial hypercholesterolemia patients were on lomitapide or evinacumab therapy.

Conclusion: The PORTRAIT survey would like to promote a network to better manage the patients on chronic LA.

Introduction: Therapeutic plasmapheresis (TP) is an extracorporeal treatment method used for a variety of patients with various diseases.

Methods: For this retrospective study, patients who were admitted to the pediatric intensive care unit (PICU) and received TP therapy between 2013 and 2023, and whose medical records were reached, were included.

Results: A total of 72 children were included in the study. The most common indication for TP was septic shock, followed by multisystem inflammatory syndrome in children (MIS-C). The median number of TP sessions was 2, and the median PRISM III score was 14.5. Of the patients, 56.9% had ASFA class 3 diagnoses, and 5.6% developed thrombosis as a complication. The mortality rate was 44.4%, most of whom had an underlying disease.

Conclusion: TP is an important supportive therapy in critically ill patients admitted to PICUs. We believe that early initiation of TP may be life-saving with proper indications.

Aim: This study investigated inflammatory markers involved in the pathogenesis of atherosclerosis in patients with Chronic Kidney Disease (CKD) undergoing maintenance hemodialysis (HD).

Methods: This cross-sectional study included 144 patients with CKD (65 females, 79 males) undergoing maintenance HD and 23 healthy controls (12 females, 11 males). Serum concentrations of Transforming Growth Factor-β (TGF-β), C-reactive protein (CRP), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) were determined. Group comparisons were performed, and associations were examined using crude and multivariable-adjusted logistic regression models.

Results: TGF-β, NLR, and PLR levels were significantly higher in HD patients than in controls (p < 0.001, p < 0.001, and p = 0.041, respectively), along with elevated CRP (p < 0.001). ROC analysis showed good diagnostic performance for TGF-β (AUC 0.812) and NLR (AUC 0.863), but weaker for PLR (AUC 0.633). In the crude logistic regression analysis, all three markers demonstrated significant associations with end-stage renal disease (ESRD). After adjustment for age, sex, hypertension, cardiovascular disease (CVD), malignancy, and inflammatory diseases, TGF-β remained significantly associated with ESRD (OR: 1.026; 95% CI: 1.003-1.050; p = 0.027). Similarly, after adjustment for age, sex, hypertension, CVD, diabetes mellitus (DM), malignancy, and inflammatory diseases, NLR was independently associated with ESRD (OR: 8.196; 95% CI: 1.554-43.227; p = 0.013). Finally, following adjustment for age, sex, hypertension, CVD, DM, and malignancy, PLR also showed a significant association with ESRD (OR: 1.019; 95% CI: 1.002-1.037; p = 0.033).

Conclusion: Inflammatory markers, including TGF-β, NLR, and PLR, are significantly elevated in patients with CKD receiving maintenance HD compared with healthy individuals. These markers are associated with HD even after adjusting for significant covariates.