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: Therapeutic plasma exchange (TPE) is crucial for saving lives when used appropriately. This study aimed to assess TPE's impact on tumor necrosis factor-like weak inducer of apoptosis (TWEAK) protein and IL-6 levels in critically ill pediatric patients.

Methods: Conducted between May 2022 and December 2022, the study observed pediatric intensive care unit (PICU) patients undergoing TPE, recording demographics, lab results, TWEAK, and IL-6 levels pre- and post-procedure.

Results: Of 41 patients, 53.7% were male, 51.2% had underlying conditions, and 39% showed sepsis symptoms. IL-6 levels significantly rose post-TPE (p: 0.006), while TWEAK protein levels dropped (p: 0.030). Positive correlations were found between interleukin-6 (IL-6) pre-TPE and ventilation duration, ferritin levels (p <0.05), and TWEAK pre-TPE and organ failure indicators, D-Dimer levels (p <0.05). Prognosis showed no significant difference in IL-6/TWEAK levels (p >0.05).

Conclusion: Serum IL-6 and TWEAK can indicate disease severity and inflammation level, but may not predict prognosis accurately.

Clinical trial registration: Our study has clinical study registration number B.10.1.TKH.4.34.H.GP.0.01/154 of the University of Health Sciences Ümraniye Training and Research Hospital.

Introduction: The objective of this study is to investigate the dynamic changes in serum albumin and ferritin as potential predictors for early-onset peritoneal dialysis-related peritonitis (PDRP) in patients undergoing peritoneal dialysis (PD).

Methods: This retrospective study included 215 patients with end-stage renal disease who initiated PD at Huadong Hospital. Patients were followed up to 24 months, during which episodes of PDRP were recorded. The dynamic changes in serum albumin and ferritin levels were evaluated within the first 6 months of PD initiation. Data were analyzed to assess the relationship between these biomarkers and early-onset PDRP.

Results: Among the 215 patients, 33.49% developed PDRP, and 28.93% experienced early-onset PDRP. Patients with lower baseline serum albumin levels (<35 g/L) and higher baseline ferritin levels (≥400 μg/L) had an increased risk of developing early-onset PDRP. Importantly, the risk associated with low initial albumin was not significant when serum albumin levels remained stable within the first 6 months (-5% to 5% change). Similarly, although higher baseline ferritin was associated with a higher risk of early-onset PDRP, patients with fluctuating ferritin levels (more than 35% change) showed no significant increase in the risk. Kaplan-Meier analysis revealed a lower cumulative technical survival rate in patients with early-onset PDRP.

Conclusion: Dynamic changes in serum albumin and ferritin levels within the first 6 months of PD can serve as significant predictors of early-onset PDRP, but stable levels of these markers mitigate their predictive value. Close monitoring of these biomarkers may help in identifying high-risk patients and improving PD outcomes.

Introduction: The efficacy of lipoprotein apheresis (LA) in peripheral arterial disease (PAD) has been primarily attributed to its anti-atherosclerotic effects through the adsorption of lipoproteins. However, the other potential effects of LA remain unknown. We evaluated changes in serum profiles before and after LA using a comprehensive analysis to explore the underlying mechanism.

Methods: Ten patients with leg ulcers were included from the LETS-PAD study, in which patients with lipoprotein-controlled PAD underwent LA. Serum samples collected at baseline and 1 month after LA were analyzed for proteomic changes.

Results: Six patients exhibited ulcer epithelialization and skin perfusion pressure improvement. Proteomic analysis identified 2033 proteins. Fifty-five proteins showed significant differences. B-cell lymphoma protein-2 associated X (BAX) and C-X-C motif chemokine 10 (CXCL10) were downregulated.

Conclusion: Serum BAX and CXCL10 levels significantly decreased after LA, which may be involved in the ulcer epithelialization mechanism of LA, which potentially acts through angiogenesis promotion.

Introduction: End-stage kidney disease patients face a critical decision regarding kidney replacement therapy options, which include kidney transplantation, hemodialysis, or peritoneal dialysis (PD). This study aims to evaluate the impact of nurse-led education (NE) alone vs. NE combined with peer support on the patients' decision over PD treatment in chronic kidney disease patients.

Methods: The study was conducted between 2018 and 2020, and patients were prospectively followed for the years 2018-2020. A total of 238 patients were selected from 500 outpatient clinic patients based on inclusion criteria and the principle of voluntary participation. Among 238 patients, 112 patients who received NE plus peer support as well as NE. Generalized linear models (GLM) analysis was employed to investigate the influence of NE and NE plus peer support on the decision of PD by patients.

Results: In the NE plus peer support group, 38% were aged 45-59, and 65% were male. Similarly, in the NE group, 38% were aged 45-59, and 60% were male. The study utilized GLM to analyze patients' decisions regarding the PD treatment. Model 1 examined the duration of NE plus peer support (Akaike Information Criterion [AIC] = 130.46, McFadden's pseudo-R-squared (ρ²) = 0.569), Model 2 focused on the duration of NE (AIC = 294.11, McFadden's ρ² = 0.011), Model 3 assessed the sufficiency of NE plus peer support (AIC = 142.98, McFadden's ρ² = 0.526), and Model 4 evaluated the sufficiency of NE alone (AIC = 296.53, McFadden's ρ² = 0.085).

Conclusions: Education provided by nurse and supported by peer affects patients' decision of kidney replacement treatment. Through the implementation of effective peer education, healthcare providers can enable patients to make informed decisions that align with their personal values, preferences, and treatment objectives, thereby enhancing clinical outcomes and overall patient satisfaction.

Introduction: Diabetes, obesity, and CKD collectively impact musculoskeletal health and increase the risk of severe coronavirus disease 2019 (COVID-19) outcomes.

Methods: This cross-sectional study included 32 dialysis patients, categorized based on their COVID-19 status. Laboratory assessments included inflammatory markers (IL-1β, IL-6, IL-8, and TNF-α). Sarcopenia risk was evaluated using the strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire, bioimpedance analysis, and static muscle strength testing.

Results: No significant differences were observed between groups in laboratory values, sarcopenia risk, or inflammatory markers. Body composition, SARC-F scores, and static muscle strength were comparable across both groups, except for elevated parathyroid hormone (PTH) levels in Group A (p = 0.008).

Conclusion: The lack of association between the inflammatory response and sarcopenia risk may be attributed to the existing inflammatory status of this population, given the coexistence of diabetes, CKD, and obesity. Notably, all studied laboratory variables showed no significant differences, except for the higher PTH levels.

Introduction: To investigate the clinical efficacy and safety of plasma exchange (PE) in the treatment of glucocorticoid-insensitive patients with serum anti-N-methyl-d-aspartate (anti-NMDA) receptor antibody-negative and serum anti-NMDA receptor antibody-positive encephalitis.

Methods: The clinical data of 20 patients with anti-NMDA receptor antibody encephalitis treated between January 2015 and December 2022 were collected. The general information, clinical symptoms, auxiliary examination, treatment (hormone, PE, etc.), adverse reactions, clinical efficacy, and other related data were retrospectively compared and analyzed.

Results: A total of 8 cases had adverse reactions (9.76%, 8/82), including 4 cases (4.88%, 4/82) of allergy and 2 cases (2.44%,2/82) of thrombocytopenia. In patients with anti-NMDA receptor antibody encephalitis who were not sensitive to glucocorticoids, the effective rate of PE was 80.0% (p = 0.0005).

Conclusion: PE combined with glucocorticoid is more effective than glucocorticoid alone in the treatment of anti-NMDA receptor antibody encephalitis patients with positive or negative anti-NMDA receptor antibodies. Most adverse reactions were mild and easy to manage. It does not cause obvious blood cell loss. PE is a safe and acceptable treatment. However, our study has limitations, and due to the small number of people and the fact that plasmapheresis was performed after glucocorticoid therapy, further prospective clinical studies are warranted.

Background: Chatbots produced by artificial intelligence are frequently used in health information today. We aimed to investigate the reliability and reproducibility of the answers given by Chat Generative Pretrained Transformer (ChatGPT), one of the most used chatbots, to frequently asked questions related to chronic kidney failure.

Methods: We reviewed frequently asked questions related to chronic kidney disease (CKD) from social media platforms and Internet. The questions were asked to ChatGPT, and the answers were scored from 1 to 4 by two experienced nephrologists.

Results: Eighty-five frequently asked questions about chronic renal failure were examined and 60 of them were included in the study after exclusion criteria. Fifty-one (85%) of the questions received 1 point, 7 (11.7%) received 2 points and 2 (3.3%) received 3 points. The similarity rates of the answers to the repeated questions were between 80% and 100%.

Conclusion: ChatGPT has provided reliable responses with high reproducibility to inquiries related to CKD.