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: Previously, our institution measured peripheral blood CD34 cell counts both pre- and post-peripheral blood stem cell harvest (PBSCH), with both samples analyzed simultaneously post-PBSCH. Since 2021, we have measured pre-CD34 cell counts during PBSCH, adjusting the processed blood volume based on these results. We retrospectively evaluated how this change impacted cellular therapy.
Methods: Related healthy donors were included and divided into 1-day and 2-day harvest cohorts. Donors with CD34 cell counts measured post- and during PBSCH were categorized into the previous and current sub-cohorts, respectively.
Results: Regarding the 1-day cohort (n = 212), the current sub-cohort had a significantly shorter average harvest duration (151 [standard deviation, SD = 45.1] vs. 180 [SD = 27.8] minutes, respectively) and higher average infusion rates (87.6% [SD = 21.1] vs. 78.1% [SD = 25.7], respectively) than the previous sub-cohort.
Conclusion: Adjusting the processed blood volume based on pre-PBSCH CD34 cell counts measured during the harvest may reduce donor burden and enhance workflow efficiency.
{"title":"Improving cellular therapy operations through pre-harvest measurement of peripheral CD34-positive cell counts in allogeneic stem cell harvest.","authors":"Shuhei Kurosawa, Kyoko Haraguchi, Yunoka Honma, Fuyuko Kawai, Moemi Ishiwada, Ryoko Iimura, Rei Watanabe, Sayuri Ishibashi, Kae Sakuma, Kiyomi Narishima, Misako Nishimura, Takashi Toya, Hiroaki Shimizu, Yuho Najima, Takeshi Kobayashi, Noriko Doki, Yoshiki Okuyama","doi":"10.1111/1744-9987.14202","DOIUrl":"10.1111/1744-9987.14202","url":null,"abstract":"<p><strong>Introduction: </strong>Previously, our institution measured peripheral blood CD34 cell counts both pre- and post-peripheral blood stem cell harvest (PBSCH), with both samples analyzed simultaneously post-PBSCH. Since 2021, we have measured pre-CD34 cell counts during PBSCH, adjusting the processed blood volume based on these results. We retrospectively evaluated how this change impacted cellular therapy.</p><p><strong>Methods: </strong>Related healthy donors were included and divided into 1-day and 2-day harvest cohorts. Donors with CD34 cell counts measured post- and during PBSCH were categorized into the previous and current sub-cohorts, respectively.</p><p><strong>Results: </strong>Regarding the 1-day cohort (n = 212), the current sub-cohort had a significantly shorter average harvest duration (151 [standard deviation, SD = 45.1] vs. 180 [SD = 27.8] minutes, respectively) and higher average infusion rates (87.6% [SD = 21.1] vs. 78.1% [SD = 25.7], respectively) than the previous sub-cohort.</p><p><strong>Conclusion: </strong>Adjusting the processed blood volume based on pre-PBSCH CD34 cell counts measured during the harvest may reduce donor burden and enhance workflow efficiency.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"131-140"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Estimated continuous cardiac output (esCCO) is a novel technology that enables non-invasive and continuous monitoring of cardiac output. We compared the concordance in accuracies among esCCO measurements in the shunt limb and non-shunt limb.
Methods: In this single-center prospective observational study, we include Japanese patients who underwent dialysis at our center between April 27, 2021, and February 28, 2023. Clinical accuracy of esCCO was evaluated in the shunted and non-shunted bilateral digits. Agreement between the measurements was analyzed using Lin's congruent correlation and Bland-Altman analysis.
Results: For 43 individuals, Lin's concordance correlation coefficient was 0.9887 (95% confidence interval of 0.9886-0.9887) indicating good agreement. The values of esCCO measured in the shunt and non-shunt limbs were compatible. The percentage errors for the 43 patients with arterio-venous fistula (AVF) or arterio-venous graft (AVG), 32 with AVF, and 11 with AVG were 9.3%, 9.3%, and 8.9%, respectively.
Conclusion: esCCO could be used in shunt as well as non-shunt limbs during dialysis, allowing continuous and non-invasive hemodynamic monitoring.
{"title":"Reliability and benefit of estimated continuous cardiac output measurement using shunt-side SpO<sub>2</sub> monitor in hemodialysis.","authors":"Koji Nakai, Yuichi Hirate, Takashi Nakajima, Atsushi Doi, Takeyuki Hiramatsu, Toshie Higaki, Aiko Nakai","doi":"10.1111/1744-9987.14193","DOIUrl":"10.1111/1744-9987.14193","url":null,"abstract":"<p><strong>Introduction: </strong>Estimated continuous cardiac output (esCCO) is a novel technology that enables non-invasive and continuous monitoring of cardiac output. We compared the concordance in accuracies among esCCO measurements in the shunt limb and non-shunt limb.</p><p><strong>Methods: </strong>In this single-center prospective observational study, we include Japanese patients who underwent dialysis at our center between April 27, 2021, and February 28, 2023. Clinical accuracy of esCCO was evaluated in the shunted and non-shunted bilateral digits. Agreement between the measurements was analyzed using Lin's congruent correlation and Bland-Altman analysis.</p><p><strong>Results: </strong>For 43 individuals, Lin's concordance correlation coefficient was 0.9887 (95% confidence interval of 0.9886-0.9887) indicating good agreement. The values of esCCO measured in the shunt and non-shunt limbs were compatible. The percentage errors for the 43 patients with arterio-venous fistula (AVF) or arterio-venous graft (AVG), 32 with AVF, and 11 with AVG were 9.3%, 9.3%, and 8.9%, respectively.</p><p><strong>Conclusion: </strong>esCCO could be used in shunt as well as non-shunt limbs during dialysis, allowing continuous and non-invasive hemodynamic monitoring.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"61-69"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-10-10DOI: 10.1111/1744-9987.14217
Le-le Li, Rui-Feng Xu, Ning He, Ta-la Hu, Wu-Niri Gao, Xi-Feng Wang, Dong-Ying Shi, Jian-Rong Zhao, Yan Meng
The most common form of replacement therapy for end-stage renal disease (ESRD) is hemodialysis, and the adequacy of hemodialysis is strongly associated with the quality of life and long-term survival of patients. Kt/V is currently one of the most important indicators for evaluating the adequacy of hemodialysis. There are many methods for measuring Kt/V, such as blood collection and measurement, dialysate measurement, bioresistive resistance, WinNonlin software analysis, and artificial intelligence. There are different views on the importance of Kt/V as an indicator of the adequacy of hemodialysis. This article provides a literature review of the various methods of measuring Kt/V and on different perspectives on Kt/V as an evaluation of hemodialysis adequacy.
{"title":"Research progress on measurement methods and evaluation of the hemodialysis adequacy index Kt/V.","authors":"Le-le Li, Rui-Feng Xu, Ning He, Ta-la Hu, Wu-Niri Gao, Xi-Feng Wang, Dong-Ying Shi, Jian-Rong Zhao, Yan Meng","doi":"10.1111/1744-9987.14217","DOIUrl":"10.1111/1744-9987.14217","url":null,"abstract":"<p><p>The most common form of replacement therapy for end-stage renal disease (ESRD) is hemodialysis, and the adequacy of hemodialysis is strongly associated with the quality of life and long-term survival of patients. Kt/V is currently one of the most important indicators for evaluating the adequacy of hemodialysis. There are many methods for measuring Kt/V, such as blood collection and measurement, dialysate measurement, bioresistive resistance, WinNonlin software analysis, and artificial intelligence. There are different views on the importance of Kt/V as an indicator of the adequacy of hemodialysis. This article provides a literature review of the various methods of measuring Kt/V and on different perspectives on Kt/V as an evaluation of hemodialysis adequacy.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Biological invasions may promote the onset of systemic inflammatory response syndrome in patients eligible for continuous renal replacement therapy (CRRT), leading to poor prognosis. Hence, we aimed to examine the inflammatory reactions in circulation using vitamin E-coated polysulfone hollow fiber membrane (ViLIFE).
Methods: Lipopolysaccharides were intravenously administered to pigs (2 μg/kg/30 min) to establish an acute inflammation model. Extracorporeal circulation was performed for 6 h in continuous venovenous hemodiafiltration mode using a hemofilter for CRRT filled with a polysulfone hollow fiber membrane or ViLIFE, and the differences in inflammatory reactions were evaluated.
Results: The ViLIFE group exhibited low platelet and cytokine levels (p < 0.05 vs. sham-CRRT group). Additionally, the ViLIFE group had lower lactate and high mobility group box 1 levels than the other groups.
Conclusion: ViLIFE represents a promising CRRT modality that can inhibit the inflammatory response in circulation and inhibit further biological invasions.
{"title":"Continuous renal replacement therapy with vitamin E-coated polysulfone hemofilter reduces inflammatory responses in a porcine lipopolysaccharide-treated model.","authors":"Takumi Horikawa, Kana Yagi, Chika Ishikawa, Machi Atarashi, Atsushi Watanabe, Yoshihisa Kato","doi":"10.1111/1744-9987.14183","DOIUrl":"10.1111/1744-9987.14183","url":null,"abstract":"<p><strong>Introduction: </strong>Biological invasions may promote the onset of systemic inflammatory response syndrome in patients eligible for continuous renal replacement therapy (CRRT), leading to poor prognosis. Hence, we aimed to examine the inflammatory reactions in circulation using vitamin E-coated polysulfone hollow fiber membrane (ViLIFE).</p><p><strong>Methods: </strong>Lipopolysaccharides were intravenously administered to pigs (2 μg/kg/30 min) to establish an acute inflammation model. Extracorporeal circulation was performed for 6 h in continuous venovenous hemodiafiltration mode using a hemofilter for CRRT filled with a polysulfone hollow fiber membrane or ViLIFE, and the differences in inflammatory reactions were evaluated.</p><p><strong>Results: </strong>The ViLIFE group exhibited low platelet and cytokine levels (p < 0.05 vs. sham-CRRT group). Additionally, the ViLIFE group had lower lactate and high mobility group box 1 levels than the other groups.</p><p><strong>Conclusion: </strong>ViLIFE represents a promising CRRT modality that can inhibit the inflammatory response in circulation and inhibit further biological invasions.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"96-105"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141500093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction and aim: Peritonitis is a critical complication in peritoneal dialysis (PD) patients, making compliance with personal hygiene essential. This study examines the impact of the COVID-19 (Coronavirus Disease 2019) pandemic on hygiene behaviors and peritonitis incidence in PD patients.
Materials and methods: Fifty-two PD patients were assessed for hygiene behaviors, demographic, and medical data. Laboratory parameters and peritonitis culture results were compared before and after COVID-19.
Results: Post-COVID-19, significant improvements were observed in 11 hygiene behaviors, including hand washing (p < 0.001). The peritonitis rate decreased from 28.8.% to 13.5%, though this was not statistically significant (p = 0.093). Among those without post-COVID peritonitis, hand washing before connecting the transfer set and regular exit site dressing were more frequent.
Conclusion: Following COVID-19, PD patients demonstrated improved hygiene behaviors and reduced peritonitis rates. Emphasis on hand washing and exit site care is recommended in all PD programs.
{"title":"The effect of COVID-19 pandemic on personal hygiene behavior and the frequency of peritonitis in peritoneal dialysis patients.","authors":"Ezgi Simsek, Dilek Barutcu Atas, Murat Tugcu, Arzu Velioglu, Izzet Hakki Arikan, Ebru Asicioglu","doi":"10.1111/1744-9987.14251","DOIUrl":"https://doi.org/10.1111/1744-9987.14251","url":null,"abstract":"<p><strong>Introduction and aim: </strong>Peritonitis is a critical complication in peritoneal dialysis (PD) patients, making compliance with personal hygiene essential. This study examines the impact of the COVID-19 (Coronavirus Disease 2019) pandemic on hygiene behaviors and peritonitis incidence in PD patients.</p><p><strong>Materials and methods: </strong>Fifty-two PD patients were assessed for hygiene behaviors, demographic, and medical data. Laboratory parameters and peritonitis culture results were compared before and after COVID-19.</p><p><strong>Results: </strong>Post-COVID-19, significant improvements were observed in 11 hygiene behaviors, including hand washing (p < 0.001). The peritonitis rate decreased from 28.8.% to 13.5%, though this was not statistically significant (p = 0.093). Among those without post-COVID peritonitis, hand washing before connecting the transfer set and regular exit site dressing were more frequent.</p><p><strong>Conclusion: </strong>Following COVID-19, PD patients demonstrated improved hygiene behaviors and reduced peritonitis rates. Emphasis on hand washing and exit site care is recommended in all PD programs.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullah Al-Hwiesh, Abdelgalil Moaz Mohammed, Amani Al-Hwiesh, Ibrahiem Saeed Abdul-Rahman, Khadija M Alshehabi, Reema Al-Hwiesh, Nadia Al-Audah
{"title":"Not everything shining is gold: Strawberry can mimic hemoperitoneum.","authors":"Abdullah Al-Hwiesh, Abdelgalil Moaz Mohammed, Amani Al-Hwiesh, Ibrahiem Saeed Abdul-Rahman, Khadija M Alshehabi, Reema Al-Hwiesh, Nadia Al-Audah","doi":"10.1111/1744-9987.14254","DOIUrl":"https://doi.org/10.1111/1744-9987.14254","url":null,"abstract":"","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Progressive encephalomyelitis with rigidity and myoclonus (PERM) is characterized by brainstem symptoms, muscle rigidity, and myoclonus. While autoantibodies to inhibitory neurons have been associated with the pathology, about 30% of cases are negative for autoantibodies. There are few reported cases of antibody-negative PERM and its clinical course and prognosis are unknown.
Methods: We report three cases of antibody-negative PERM in which plasma exchange was effective.
Results: Case 1 was a 68-year-old man, case 2 was a 27-year-old woman, and case 3 was a 47-year-old woman. In all three cases, steroid pulse therapy and intravenous immunoglobulin had limited effect and plasma exchange was markedly effective. All patients experienced disease relapse, which was effectively treated with plasma exchange.
Conclusion: In the present cases of antibody-negative PERM, plasma exchange was most effective and was maintained long-term despite repeated relapses. Plasma exchange should be actively chosen in antibody-negative PERM.
{"title":"Efficacy of apheresis in antibody-negative progressive encephalomyelitis with rigidity and myoclonus.","authors":"Yohei Aoki, Mayumi Sakata, Hidekazu Suzuki, Kohei Hori, Junko Taruya, Katsuichi Miyamoto","doi":"10.1111/1744-9987.14253","DOIUrl":"https://doi.org/10.1111/1744-9987.14253","url":null,"abstract":"<p><strong>Introduction: </strong>Progressive encephalomyelitis with rigidity and myoclonus (PERM) is characterized by brainstem symptoms, muscle rigidity, and myoclonus. While autoantibodies to inhibitory neurons have been associated with the pathology, about 30% of cases are negative for autoantibodies. There are few reported cases of antibody-negative PERM and its clinical course and prognosis are unknown.</p><p><strong>Methods: </strong>We report three cases of antibody-negative PERM in which plasma exchange was effective.</p><p><strong>Results: </strong>Case 1 was a 68-year-old man, case 2 was a 27-year-old woman, and case 3 was a 47-year-old woman. In all three cases, steroid pulse therapy and intravenous immunoglobulin had limited effect and plasma exchange was markedly effective. All patients experienced disease relapse, which was effectively treated with plasma exchange.</p><p><strong>Conclusion: </strong>In the present cases of antibody-negative PERM, plasma exchange was most effective and was maintained long-term despite repeated relapses. Plasma exchange should be actively chosen in antibody-negative PERM.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients on dialysis often develop hyperphosphatemia, contributing to an increased risk of cardiovascular events and mortality. Currently, several types of phosphate binders (PBs) exist for the treatment of hyperphosphatemia, but they are sometimes associated with drug-specific side effects and high pill burden, making it difficult to control serum phosphorus appropriately. Tenapanor, which has a novel mechanism to reduce serum phosphorus via selective sodium/proton exchange transporter 3 inhibition, was approved for hyperphosphatemia in Japan in 2023. Four phase 3 studies of tenapanor have been performed in Japan and have demonstrated its efficacy and safety as a single-agent drug, add-on effects to PBs for patients with refractory hyperphosphatemia that cannot be improved with PBs alone, and reduction of the pill burden associated with PBs. This review provides an overview of the characteristics and previous clinical studies of tenapanor and describes the clinical benefits of tenapanor over current therapy in patients on dialysis.
{"title":"Tenapanor: A novel therapeutic agent for dialysis patients with hyperphosphatemia.","authors":"Tadao Akizawa, Natsuki Urano, Kazuaki Ikejiri, Kaoru Nakanishi, Masafumi Fukagawa","doi":"10.1111/1744-9987.14241","DOIUrl":"https://doi.org/10.1111/1744-9987.14241","url":null,"abstract":"<p><p>Patients on dialysis often develop hyperphosphatemia, contributing to an increased risk of cardiovascular events and mortality. Currently, several types of phosphate binders (PBs) exist for the treatment of hyperphosphatemia, but they are sometimes associated with drug-specific side effects and high pill burden, making it difficult to control serum phosphorus appropriately. Tenapanor, which has a novel mechanism to reduce serum phosphorus via selective sodium/proton exchange transporter 3 inhibition, was approved for hyperphosphatemia in Japan in 2023. Four phase 3 studies of tenapanor have been performed in Japan and have demonstrated its efficacy and safety as a single-agent drug, add-on effects to PBs for patients with refractory hyperphosphatemia that cannot be improved with PBs alone, and reduction of the pill burden associated with PBs. This review provides an overview of the characteristics and previous clinical studies of tenapanor and describes the clinical benefits of tenapanor over current therapy in patients on dialysis.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge.
Methods: Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves.
Results: A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls.
Conclusion: While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.
目的:评价COVID-19幸存者出院后采血的短期和长期临床和财务结果。方法:对重症监护病房出院患者进行6个月的随访。分析生命体征、实验室指标、生活质量和直接医疗费用,计算增量成本-效果比(ICER),绘制成本-效果平面和可接受曲线。结果:共纳入68例患者,其中对照组45例,血浆置换18例,血液灌流5例。血浆置换和血液灌注患者出院时的ICERs分别为每获得的质量调整生命年(QALY) 867.58美元和198.89美元。出院时呼吸和血压明显改善。血浆置换组和血液灌注组氧合指标的改善均低于对照组(SpO2组为8.56±10.31和11.75±16.88,SpO2组为11.37±7.28%;PaO2组为11.15±21.15和11.05±24.95,PaO2组为16.03±5.61 mm Hg)。然而,呼吸频率的改善与血浆置换组和血液灌注组的ICERs分别为1034.77美元和269.94美元。提高平均动脉压的ICERs分别为每毫米汞柱24.83美元和30.94美元,血浆置换在提高血清钙水平方面比血液灌注更具成本效益(每毫克/分升1649.35美元)。在出院后1个月,两种治疗方法的结果都比对照组差。6个月时,血浆置换ICER($1884.95)超过了支付意愿阈值。6个月血浆置换的ICER为每避免再住院日112.83美元,而血液灌流仍然不如对照组有效。结论:虽然血浆置换和血液灌流改善了一些临床结果,但其高昂的成本和有限的长期成本效益表明,这些干预措施在治疗COVID-19患者方面可能不具有经济合理性。在考虑其在临床实践中的应用时,需要仔细评估。
{"title":"Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge.","authors":"Soroush Dianaty, Farshid Gholami, Hamid Reza Gholamrezaie, Abasat Mirzaei","doi":"10.1111/1744-9987.14235","DOIUrl":"https://doi.org/10.1111/1744-9987.14235","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge.</p><p><strong>Methods: </strong>Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves.</p><p><strong>Results: </strong>A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO<sub>2</sub>, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO<sub>2</sub>, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls.</p><p><strong>Conclusion: </strong>While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Qiuling Zhang, Jun Dou, Hua Ao, Dongmei Guo, Xi Yang, Ming Li
Introduction: Transcutaneous auricular vagus nerve stimulation (tVNS) has shown potential in neurological, autoimmune, and cardiovascular disorders, but its effects on HD patients remain unclear. This study aimed to evaluate the efficacy and safety of tVNS in HD patients.
Methods: We conducted a randomized controlled clinical trial on patients receiving HD ≥6 months. The tVNS group received stimulation for 1 h during the first 2 h of HD sessions, three times weekly for 8 weeks, while the control group received standard care. The primary outcomes were dialysis efficiency (Single-pool Kt/V, Sp Kt/V) and dialysis-related symptoms (Dialysis Symptom Index, DSI), assessed every 4 weeks. Secondary outcomes included pain and fatigue scores, physical performance, Hemodialysis Comfort Scale, hemoglobin levels, Mini-Mental State Examination, and anxiety and depression scores, measured at baseline and 8 weeks after intervention.
Results: A total of 63 patients were enrolled in the study, with 32 patients assigned to the tVNS group and 31 patients to the control group. At 8 weeks, the tVNS group showed significant improvements in Sp Kt/V (1.31 ± 0.11 vs. 1.25 ± 0.10, p = 0.02), and DSI (12.09 ± 5.84 vs. 16.26 ± 5.27, p = 0.004), as well as reductions in pain and fatigue, and increases in physical function, comfort, and hemoglobin. However, there were no statistically significant changes observed in cognitive function, anxiety, or depression.
Conclusions: tVNS could improve dialysis efficiency, symptoms, and physical function in HD patients, indicating it may have a role as a complementary therapy.
{"title":"Effect of transcutaneous vagus nerve stimulation in hemodialysis patients: A randomized controlled trial.","authors":"Qiuling Zhang, Jun Dou, Hua Ao, Dongmei Guo, Xi Yang, Ming Li","doi":"10.1111/1744-9987.14243","DOIUrl":"https://doi.org/10.1111/1744-9987.14243","url":null,"abstract":"<p><strong>Introduction: </strong>Transcutaneous auricular vagus nerve stimulation (tVNS) has shown potential in neurological, autoimmune, and cardiovascular disorders, but its effects on HD patients remain unclear. This study aimed to evaluate the efficacy and safety of tVNS in HD patients.</p><p><strong>Methods: </strong>We conducted a randomized controlled clinical trial on patients receiving HD ≥6 months. The tVNS group received stimulation for 1 h during the first 2 h of HD sessions, three times weekly for 8 weeks, while the control group received standard care. The primary outcomes were dialysis efficiency (Single-pool Kt/V, Sp Kt/V) and dialysis-related symptoms (Dialysis Symptom Index, DSI), assessed every 4 weeks. Secondary outcomes included pain and fatigue scores, physical performance, Hemodialysis Comfort Scale, hemoglobin levels, Mini-Mental State Examination, and anxiety and depression scores, measured at baseline and 8 weeks after intervention.</p><p><strong>Results: </strong>A total of 63 patients were enrolled in the study, with 32 patients assigned to the tVNS group and 31 patients to the control group. At 8 weeks, the tVNS group showed significant improvements in Sp Kt/V (1.31 ± 0.11 vs. 1.25 ± 0.10, p = 0.02), and DSI (12.09 ± 5.84 vs. 16.26 ± 5.27, p = 0.004), as well as reductions in pain and fatigue, and increases in physical function, comfort, and hemoglobin. However, there were no statistically significant changes observed in cognitive function, anxiety, or depression.</p><p><strong>Conclusions: </strong>tVNS could improve dialysis efficiency, symptoms, and physical function in HD patients, indicating it may have a role as a complementary therapy.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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