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: Oxidative stress (OS), inflammation, and lipoprotein dysfunction contribute to the high cardiovascular disease (CVD) risk in chronic kidney disease (CKD) patients undergoing hemodialysis (HD). This study examined whether OS-related biomarkers-myeloperoxidase (MPO), paraoxonase-1 (PON1), and homocysteine (HCY)-and their derived ratios (MPO/PON1, MPO/HDL-C, PON1/HDL-C) are associated with cardiovascular risk.

Methods: A case-control study was conducted including 42 HD patients and 42 matched healthy controls. Plasma HCY levels, MPO activity, and PON1 activity were measured, along with lipid profiles. Functional OS ratios were calculated.

Results: HD patients showed higher MPO activity and HCY levels and lower PON1 activity compared with controls (p < 0.001). MPO/PON1 and MPO/HDL-C ratios were significantly elevated before and after dialysis, indicating increased oxidative imbalance.

Conclusion: The MPO/PON1 ratio may represent a novel biomarker of OS and CVD risk in HD patients, supporting the evaluation of HDL functionality for improved risk stratification.

Aim: Procalcitonin (PCT) interpretation in chronic kidney disease (CKD) patients is challenging, as levels may rise even without infections. This study aimed to evaluate PCT dynamics during bacterial infections across CKD stages and assess its diagnostic utility.

Material and methods: In this retrospective, single-center study, 505 hospitalized patients (293 with CKD and 212 controls) with confirmed bacterial infections were included. Patients were classified according to KDIGO CKD stages. PCT levels were measured at 24, 48, 72, 96 h, and at discharge.

Results: PCT levels were significantly higher in CKD patients compared to those without CKD at all time points. Levels tended to increase or remain elevated with advancing CKD stage, except in stage 5. A significant decline in PCT was observed at the 96th hour, with a delayed decrease in advanced CKD.

Conclusion: PCT is a valuable biomarker for bacterial infections in CKD; however, stage-specific thresholds may be necessary to avoid misdiagnosis and improve clinical utility.

Background: Lipoprotein apheresis reduces low-density lipoprotein (LDL) cholesterol in high-risk patients, but its effects on plasma ion levels remain unclear. The objective of this study was to systematically evaluate the impact of apheresis on plasma calcium, sodium, potassium, magnesium, and chloride concentrations.

Methods: Following PRISMA guidelines, we searched MEDLINE/PubMed, Scopus, and Web of Science to June 2025. Studies reporting pre- and post-apheresis ion levels with at least two sessions were included. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Subgroup analyses and meta-regression explored heterogeneity. Publication bias was assessed with Egger's test.

Results: Twelve studies (10 publications, 328 participants) showed a significant reduction in total calcium after apheresis (WMD = -0.10 mmol/L; 95% CI = -0.15 to -0.05; p < 0.001). Effects were stronger with ≥ 12 months of treatment and in patients with heart disease. No significant changes were found for sodium, potassium, magnesium, or chloride. Meta-regression identified treatment duration and publication year as sources of heterogeneity for calcium outcomes. No publication bias was detected except potentially for magnesium.

Conclusions: Lipoprotein apheresis is associated with modest but significant reductions in plasma calcium, especially in patients with heart disease or prolonged treatment, highlighting the need for electrolyte monitoring. No consistent effects were observed for other plasma ions.

Introduction: Creatinine accumulation exacerbates outcomes in chronic kidney disease (CKD). To enhance creatinine removal and improve hemocompatibility, we developed heparin-functionalized copper-based metal-organic frameworks (CuMOFs-Hep).

Methods: CuMOFs were heparinized via APTES bridging and characterized (XRD, SEM, FTIR, XPS, and zeta potential). Adsorption was evaluated in simulated CKD serum and was fitted with isotherm models. Whole-blood samples from patients/healthy donors were tested. Biosafety was assessed by Cu²⁺ leaching and platelet assays.

Results: Heparinization increased surface negative charge and raised the maximum capacity to 267.8 mg g^-1 (68.7% over pristine; Langmuir R² = 0.983). Adsorption kinetics studies indicate rapid clearance of creatinine, achieving a clearance rate of 65.9% within 30 min at 37°C and reaching 75.0% within 2 h. In patient blood (854.2 μmol/L), supernatant creatinine decreased to 163.2 μmol/L (80.9% removal). Cu²⁺ leaching dropped to 0.214 ppm (-89.9%), with reduced platelet adhesion/activation.

Conclusion: CuMOFs-Hep enables efficient, low-leaching creatinine adsorption in clinically relevant matrices, highlighting its promising potential as an efficient adsorbent for blood purification applications.

Introduction: Creatinine accumulation exacerbates outcomes in chronic kidney disease (CKD). To enhance creatinine removal and improve hemocompatibility, we developed heparin-functionalized copper-based metal-organic frameworks (CuMOFs-Hep).

Methods: CuMOFs were heparinized via APTES bridging and characterized (XRD, SEM, FTIR, XPS, zeta potential). Adsorption was evaluated in simulated CKD serum and was fitted with isotherm models. Whole-blood samples from patients/healthy donors were tested. Biosafety was assessed by Cu²⁺ leaching and platelet assays.

Results: Heparinization increased surface negative charge and raised the maximum capacity to 267.8 mg g^-1 (68.7% over pristine; Langmuir R² = 0.983). Adsorption kinetics studies indicate rapid clearance of creatinine, achieving a clearance rate of 65.9% within 30 min at 37°C and reaching 75.0% within 2 h. In patient blood (854.2 μmol/L), supernatant creatinine decreased to 163.2 μmol/L (80.9% removal). Cu²⁺ leaching dropped to 0.214 ppm (-89.9%), with reduced platelet adhesion/activation.

Conclusion: CuMOFs-Hep enables efficient, low-leaching creatinine adsorption in clinically relevant matrices, highlighting its promising potential as an efficient adsorbent for blood purification applications.

Introduction: Lupus nephritis is one of the most serious complications of systemic lupus erythematosus (SLE) and can lead to end-stage kidney disease (ESKD). We aimed to assess the relative mortality risk associated with SLE among dialysis patients.

Methods: This retrospective longitudinal cohort study included all dialysis patients in the Okinawa Dialysis Study 30 registry. Cox proportional hazard models were performed to assess mortality.

Results: Of 5246 patients, 111 had ESKD secondary to SLE. Compared with ESKD patients secondary to other causes, those with SLE had significantly higher risk of death (HR 2.55, 95% CI 1.81-3.47, p < 0.0001), cardiovascular death (HR 1.94, 95% CI 1.13-3.33, p = 0.0158), and infection death (HR 4.21, 95% CI 2.40-7.37, p < 0.0001) after adjusting for age, era of dialysis initiation, and sex.

Conclusion: SLE may be independently associated with an increased risk of death in dialysis patients.

Background: Chronic kidney disease is a growing public health problem worldwide, and the number of patients requiring renal replacement therapy is steadily increasing. Türkiye has experienced a similar rise in both the incidence and prevalence of renal replacement therapy over the past decades; however, national-level projections of future renal replacement therapy demand are lacking.

Aims: This study aimed to forecast the future burden of renal replacement therapy in Türkiye by modeling historical incidence and prevalence trends using national registry data and demographic projections.

Methods: National renal replacement therapy registry data from 2012 to 2024 were analyzed together with demographic projections from the Turkish Statistical Institute extending to 2035. Four models were constructed separately for incidence and prevalence. Model performance was compared using the coefficient of determination, root mean square error, and Akaike information criterion. Leave-one-out cross-validation was used to assess model robustness. The modeling was further validated on data from Japan and the United Kingdom.

Results: All models indicated a consistent upward trend in renal replacement therapy incidence in Türkiye over the next decade. By 2035, the prevalence of renal replacement therapy in Türkiye is projected to reach approximately 1150-1250 per million population. The models demonstrated strong goodness of fit, and cross-validation supported good internal consistency, although the machine-learning model showed some overfitting for prevalence.

Conclusion: The national demand for renal replacement therapy in Türkiye is projected to continue increasing through 2035. Incorporating predictive modeling into national registry surveillance can help guide proactive capacity planning and fair resource distribution for dialysis and transplantation services. At the same time, public health strategies aimed at preventing and slowing the progression of chronic kidney disease remain essential to mitigate the growing burden of end-stage renal disease.

Background: Double filtration plasmapheresis (DFPP) is a membrane-based apheresis technique that separates plasma components using two sequential filters; it is commonly used to remove high-molecular-weight substances across various indications. While various metrics such as "plasma removal efficiency" are well established in therapeutic plasma exchange, "plasma separation efficiency" (PSE) remains unreported in DFPP. This study aims to evaluate PSE across DFPP sessions performed with plasma filters of different pore sizes.

Materials and methods: A retrospective study of DFPP procedures performed in patients with hyperlipidemia at a single center between April and July 2025 was conducted. Patient demographics, laboratory values, and procedural parameters were collected. PSE was calculated with and without hematocrit (HCT) adjustment (PSE₁ and PSE₂). Associations with procedural variables were assessed using paired tests and multivariate linear regression.

Results: A total of 42 DFPPs were performed in 19 patients using the Inuspheresis system, alternating two plasma fractionators (DFPP-1 and DFPP-2 with large and small pore size, respectively). PSE₂ and PSE₁ declined significantly from DFPP-1 to DFPP-2 (p = 0.0002 and p = 0.0014, respectively), with Cohen's d indicating large and moderate-to-large effect sizes. DFPP also resulted in significant reductions in total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, lipoprotein(a), and C-reactive protein. Multivariate models showed that the plasma separation rate and HCT shifts were significantly associated with PSE₂ and PSE₁ during DFPP-2 but not during DFPP-1.

Conclusions: PSE is a reproducible parameter influenced by membrane pore size and procedural factors. Incorporating PSE monitoring, particularly with HCT adjustment, may support optimization of individualized DFPP protocols in routine apheresis practice.

Introduction: It is known that patients receiving HD treatment experience many symptoms alone or in combination, negatively affecting their life satisfaction and happiness levels. This study was conducted to determine the effect of symptom severity on life satisfaction and happiness in patients receiving chronic hemodialysis treatment.

Method: A descriptive and cross-sectional study was conducted between April and May 2023 with 239 patients receiving treatment in four hemodialysis centers in a province in northeastern Turkey. The data were collected by face-to-face interview technique using the "Descriptive Information Form," "Dialysis Symptom Index (DSI)," "Satisfaction with Life Scale (SWLS)," and "Happiness Scale (HS)."

Results: A statistically significant difference was found between gender, exercise status, and the presence of secondary disease and HS and DSI (p < 0.05). At the same time, a significant difference was found between marital status and the SWLS and HS and between income level and smoking status and the SWLS (p < 0.05). There was a significant relationship between DSI and SWLS and HS, and DSI had a predictive effect on life satisfaction and happiness scale ( $R_{\text{adjusted}}^2:0.027$ , $R_{\text{adjusted}}^2:0.085$ ).

Conclusion: Symptom severity was below moderate, life satisfaction was reasonable, and happiness level was above average in patients receiving chronic hemodialysis treatment. A comprehensive assessment of multiple symptoms and effective symptom management is recommended in patients receiving hemodialysis.