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: Cognitive impairment and exercise intolerance are common in dialysis patients. Cerebral perfusion and oxygenation play a major role in both cognitive function and exercise execution; HD session per se aggravates cerebral ischemia in this population. This study aimed to compare cerebral oxygenation and perfusion at rest and in mild physical stress between HD and PD patients, as well as controls without CKD.

Methods: Eighty-one participants (27 HD, 27 PD and 27 controls, matched for age, sex) underwent a 3-min intermittent-handgrip-exercise at 35% of their maximal-voluntary-contraction (MVC). During exercise, cerebral oxygenation (oxyhemoglobin-O₂Hb, deoxyhemoglobin-HHb, total-hemoglobin-tHb) was assessed by near-infrared-spectroscopy.

Results: Age, sex, dialysis-vintage, and major comorbidities did not differ between groups. The average increases observed during exercise in O₂Hb (cerebral oxygenation index) were significantly impaired in both dialysis modalities compared to controls, with HD patients tending to have lower levels (HD: 1.20 ± 1.03 vs. PD: 1.53 ± 0.99 vs. Controls: 2.41 ± 1.35 μmol/L, p = 0.001). Similarly, the average HHb and tHb (HD: 0.57 ± 1.20 vs. PD: 1.21 ± 1.11 vs. Controls: 2.21 ± 1.50 μmol/L, p < 0.001) responses were significantly lower in both dialysis groups compared to controls, with a trend toward lower levels in HD patients. As for Hb_diff, a significant trend for lower values in both dialysis modalities compared to controls was observed, with no marked numerical differences between them. Blunted average responses in O₂Hb, tHb, and Hb_diff were associated with more impaired cognitive performance (MMSE score).

Conclusions: Cerebral oxygenation is blunted in both HD and PD, while HD individuals exhibit a trend toward even lower levels, potentially reflecting the cumulative cerebrovascular stress associated with intermittent dialysis.

Objective: The present study aims to explore the role of nafamostat mesylate (NM) in ischemia-reperfusion (I/R)-induced acute kidney injury (AKI).

Methods: Twenty-one male rats were randomly divided into three groups: sham, I/R, and I/R + NM groups. Acute renal I/R injury models were created in the I/R and I/R + NM groups by right nephrectomy and clamping the left renal pedicle for 45 min. Rats in the I/R + NM group were intraperitoneally injected with 0.75 mg/kg of NM before modeling. Blood and kidney specimens were collected at 24 h after model establishment. RNA sequencing (RNA-seq), KEGG and GO enrichment analyses, and single-cell sequencing were carried out to investigate the related mechanisms.

Results: The pretreatment with NM improved renal function, reduced mitochondrial damage, suppressed the accumulation of reactive oxygen species, and inhibited ferroptosis. The RNA-seq indicated that NM induced protection by upregulating fatty acids, inhibiting inflammation, and promoting DNA repair. Proximal tubular cells were mainly affected.

Conclusion: NM protects against AKI by reducing reactive oxygen species, upregulating fatty acids, and regulating ferroptosis signaling pathways in proximal tubular cells.

Objective: To clarify the difference in clinical efficacy between centrifugation filtration plasmapheresis (CFPP) and plasma exchange (PE) in treating hypertriglyceridemia-induced acute pancreatitis (HTG-AP).

Methods: Cases of HTG-AP from January 2024 to May 2024 of First Medical Center of Chinese People's Liberation Army (PLA) General Hospital were included and divided into CFPP and PE groups based on the treatment. Medical records were reviewed to collect data on patient outcomes, clinical features, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and laboratory parameters before and after the treatment of CFPP or PE. The primary outcomes were discharge conditions, length of hospital stay (LOS) and serum triglycerides (TGs) reduction rate. Secondary outcomes were the incidence of complications (renal failure, gastrointestinal bleeding, shock, pulmonary failure, pancreatic cyst, and further surgical treatment). The correlation of initiation time of blood purification and patient outcomes was also examined. Furthermore, the patients with APACHE II score < 15 were analyzed separately.

Results: A total of 26 patients were included; the basic characteristics of patients in the CFPP group and PE group were similar. There were no significant differences in patients' discharge conditions, LOS, or incidence of complications (renal failure, gastrointestinal bleeding, shock, pulmonary failure, pancreatic cyst) between CFPP and PE groups (p > 0.05). Both CFPP and PE could effectively reduce serum TG (70.72% vs. 78.8%, p = 0.565). No significant correlation between initiation time and patient outcomes was observed (p > 0.05). When patients with APACHE II scores < 15 were analyzed, there were no significant differences observed in patient outcomes between the CFPP group and PE group (p > 0.05).

Conclusions: CFPP and PE express similar efficacy in the treatment of HTG-AP patients and could effectively reduce serum TG.

Background: Therapeutic plasma exchange (TPE) involves removing the patient's plasma and replacing it with allogeneic plasma, colloid, or crystalloid. TPE is most commonly performed using either centrifugation devices or plasma filtration across high-permeability membranes. This study aims to compare centrifugation-based therapeutic plasma exchange (cTPE) versus membrane-based therapeutic plasma exchange (mTPE) in terms of performance, adverse events, and efficacy in removing inflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) in patients indicated for TPE.

Methods: In this randomized, prospective, paired crossover trial, 20 patients undergoing TPE for various therapeutic indications were enrolled. Ten patients were randomly assigned online to receive the TPE technique as follows: the first session was administered by cTPE, and the second session was administered by mTPE 48 h later. The remaining 10 patients received their first TPE session with mTPE, and 48 h later, their second session was performed with cTPE. Before and after each session, a complete blood count, serum calcium, IL-6, and TNF-alpha levels were measured, along with an assessment of plasma removal efficiency (PRE).

Results: Regarding the elimination of TNF-alpha, there was no significant difference between the two TPE techniques (p = 0.156). However, the cTPE technique demonstrated improved IL-6 elimination, longer priming, longer procedure times, and superior PRE (p = 0.028, < 0.001, 0.004, and < 0.001, respectively).

Conclusion: Compared to mTPE, cTPE technique yields more PRE and is more effective at removing cytokines, especially IL-6, though it takes more time.

Trial registration: ClinicalTrials.gov Identifier: NCT06652516.

Introduction: Despite recommendations for early nephrology referral in CKD stage G4+, emergency dialysis remains common.

Methods: This retrospective study evaluated whether pre-dialysis nephrology care duration influences outcomes after initiation. We analyzed 388 hemodialysis patients (2014-2022), divided into Short (< 3 months) and Long (> 6 months) care groups. Clinical and socioeconomic factors were compared using Fisher's exact test, Mann-Whitney U test, and Kaplan-Meier analysis.

Results: The proportion of Short Group patients did not decline over time. Ninety-day survival was significantly lower in the Short Group (p < 0.01). The Long Group had more comorbidities, such as hypertension and diabetes, likely reflecting earlier referral. The Short Group had longer hospital stays, more tunneled catheter use, and fewer AVF placements.

Conclusion: These findings suggest that nephrology care exceeding 6 months before dialysis may improve short-term survival. Promoting earlier referral of patients with CKD could reduce emergency dialysis and enhance patient outcomes.

Introduction: Hemodialysis (HD) is the most widely utilized dialysis method globally. However, hemodiafiltration (HDF) is garnering significant interest. This study aimed to evaluate mortality rates in patients with end-stage kidney disease (ESKD) using HDF in comparison to high-flux HD (hf-HD).

Methods: The Cochrane, Embase, Epistemonikos, and PubMed databases were searched until October 30, 2024.

Results: Seven studies met the inclusion criteria. Compared to the hf-HD group, the risk ratio (RR) for all-cause mortality with HDF was 0.78 (95% CI 0.68-0.89). Likewise, the risks of cardiovascular death and infection-related death were lower in the HDF group. Subgroup analysis indicated a reduction in all-cause mortality among nondiabetic patients in the HDF group. ESKD patients without preexisting cardiovascular disease (CVD) exhibited an RR of 0.61 (95% CI 0.45-0.77) for all-cause deaths.

Conclusions: The use of HDF in comparison to hf-HD reduced the risk of death in nondiabetic patients and those without preexisting CVD. Given the high cost associated with HDF, further studies are necessary to confirm these findings.

Introduction: Regional citrate anticoagulation (RCA) is increasingly utilized for therapeutic plasma exchange (TPE). Currently, many clinical studies have focused on the safety and efficacy of RCA in TPE. However, due to the complex application and the lack of a uniform standard of RCA, the results of these researches, especially citrate-related metabolic complications, varied greatly in different studies. The purpose of this meta-analysis is to assess the safety and efficacy of RCA in TPE.

Methods: We performed a comprehensive search on PubMed, Embase, and the Cochrane Library database from the inception to August 26, 2024. Studies regarding the application of RCA in TPE were included to assess the efficacy and safety of RCA in TPE. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale and the Jadad scale. Meta-analysis was performed using Stata software (version 15.1).

Results: There were 13 eligible studies included, involving 4268 RCA-TPE sessions. The pooled rate of extracorporeal circuit clotting, bleeding, citrate accumulation, hypocalcemia, hypernatremia, hypomagnesemia, and metabolic alkalosis was 5.3% (95% CI [2.4-9.2]), 2.0% (95% CI [0.2-5.0]), 1.8% (95% CI [0.0-6.7]), 17.9% (95% CI [2.3-42.5]), 1.7% (95% CI [0.0-5.1]), 45.6% (95% CI [25.9-66.0]), and 14.8% (95% CI [0.5-41.3]), respectively. Subgroup analysis of hypocalcemia and metabolic alkalosis in the membrane therapeutic plasma exchange (mTPE) was 42.1% (95% CI [2.5-89.7]) and 32.4% (95% CI [25.3-39.9]), respectively. Compared to before treatment, the serum sodium and bicarbonate significantly increased, and serum calcium decreased significantly after RCA-TPE treatment. There was no difference in platelet (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), the ratio of total calcium to ionized calcium, total calcium, pH, and base excess (BE) before and after treatment. Subgroup analyses demonstrated that pH and BE in mTPE, and APTT and PT in double filtration plasmapheresis (DFPP) were significantly increased after treatment.

Conclusion: Regional citrate anticoagulation might be effective in TPE treatments. However, the incidence of hypomagnesemia, hypocalcemia, and metabolic alkalosis is relatively high. Close monitoring and timely adjustment are needed during the process of RCA-TPE treatment to avoid these complications.

Background: The delipid extracorporeal lipoprotein filter from plasma (DELP) treatment can effectively reduce blood lipid, increase blood flow, and improve neurological deficits in patients with acute ischemic stroke (AIS). However, its effect on vision and retinal microcirculation in stroke patients has never been reported.

Methods: Between November 2023 and June 2024, five patients underwent DELP treatment as a routine adjuvant therapy for AIS. Detailed ophthalmological examinations, including best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA), were performed on them one day prior to and 1-3 days following the DELP treatment.

Results: Among the ten eyes examined, six had diabetic retinopathy (DR), two had dry age-related macular degeneration (dAMD), one had idiopathic epiretinal membrane (iERM), and one was normal. Surprisingly, after DELP treatment, the BCVA improved by 0.2LogMAR in six eyes, 0.1LogMAR in three eyes, and remained unchanged in one eye. The vessel density (VD) in the fovea increased in six eyes, remained unchanged in three eyes, and decreased in one eye. The non-perfusion area (NPA) in the superficial capillary plexus (SCP) decreased in six eyes, remained unchanged in two eyes, and increased in two eyes. The NPA in the deep capillary plexus (DCP) decreased in eight eyes and remained unchanged in two eyes. A small amount of bleeding occurred in Patient 3's right eye, and no other adverse events were observed post-treatment.

Conclusions: In this case series, the DELP treatment showed a potentially significant therapeutic effect on the BCVA and retinal microcirculation in AIS patients with good safety and provided a rationale for further investigation. At the same time, this treatment may provide an effective option for the treatment of eye diseases such as DR, iERM, and AMD.