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: Hemodialysis population commonly faces sleep problems. Sleep educational interventions are implemented to address these problems, yet evidence on their effectiveness is limited. This study aimed to evaluate the impact of sleep educational interventions on sleep problems in hemodialysis.

Methods: Following Cochrane Guidelines and PRISMA 2020, 11 electronic databases were searched. Data synthesis was performed with Comprehensive Meta-analysis version 3.

Results: This study examined six studies and revealed that sleep education significantly improved sleep quality, subjective sleep quality, sleep latency, sleep duration, sleep disturbance, and medium effect on sleep efficiency, with low to high quality of evidence. Subgroup analysis found no difference in sleep quality improvement between group and individual education methods or between using and not using educational materials. Additionally, three or fewer sessions were more effective than six in enhancing sleep quality.

Conclusion: This meta-analysis revealed that sleep education interventions positively improve sleep-related problems.

Trial registration: PROSPERO: CRD42024523225.

Introduction: To early detect intradialytic hypotension, we used continuous finger-cuff blood pressure technology in our hemodialysis patients. We noticed differences between noninvasive blood pressure measurements at the brachial and finger sites. Such discrepancies might reveal arterial property changes from proximal to distal arm. We then investigated if blood pressure discrepancies helped predict intradialytic hypotension for each hemodialysis session.

Methods: For our outpatient hemodialysis patients, we applied a continuous noninvasive finger-cuff blood pressure monitor at the beginning of each hemodialysis, and measured the brachial blood pressure at 15-min intervals. The blood pressure discrepancy is calculated as finger minus brachial blood pressure. Intradialytic hypotension is defined as an absolute nadir systolic blood pressure of 100 mmHg for baseline systolic blood pressure > 160 mmHg or a nadir of 90 mmHg otherwise. The vital signs and discrepancy trend evolution were analyzed with locally weighted scatterplot smoothing regression analysis.

Findings: In 42 hemodialysis sessions of 15 enrolled patients, there were 11 hypotensive episodes. For these hypotensive episodes, a smaller predialytic blood pressure discrepancy with a lower brachial diastolic and pulse pressure was noted. Combining these three vital sign measurements, a simple formula of [SBParm + DBParm - DBPfinger] at the predialytic stage predicts intradialytic hypotension.

Discussion: Calculation of the diastolic blood pressure discrepancy with the finger-cuff blood pressure measurement at the beginning of dialysis helped predict intradialytic hypotension.

With the ongoing development of the Chinese economy, the occurrence of chronic kidney disease (CKD) has experienced a remarkable upsurge recently, and due to uremia caused by CKD, the number of patients undergoing dialysis has shown a dramatic increase. China has been ranked first in the world for patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) with approximately one million patients across the country. Due to the loss of kidney function caused by CKD, the kidneys tend to lose their ability to excrete uric acid (UA) out of the body; therefore, most patients undergoing dialysis are complicated with hyperuricemia (HUA). HUA is an abnormal disease of purine metabolism, and it's considered a chronic disease. More than 90% of patients suffering from HUA will not show any symptoms on physical examination. According to statistics, if high serum UA is left untreated, 55% of patients will develop severe problems due to the purine crystallization in the body, and the kidneys are the most affected organs by HUA causing renal insufficiency that can promote end-stage kidney disease (ESKD) by activating the renin-angiotensin system (RAS), which will lead to inflammation, arteriosclerosis, cardiovascular diseases (CVD), and other diseases. Lifestyle modifications and pharmacological interventions are the first primary choice for lowering UA, although dialysis will tend to reduce the high UA levels in the blood, drugs are also necessary. This review will summarize the mechanisms and metabolism of UA, the relationship between HUA and ESKD progression, HUA and inflammation, HUA and CVD, and pharmacological treatment of HUA.

Objectives: This study evaluated and compared the clinical efficacy of low-site catheter placement combined with long-segment rectus abdominis embedding versus conventional peritoneal dialysis catheter placement.

Methods: The study included 101 patients who underwent peritoneal dialysis catheter placement at our hospital between January 2016 and December 2019. The participants were divided into two groups based on the catheter placement technique: 60 patients received low-site catheter placement with long-segment rectus abdominis embedding, and 41 patients underwent conventional catheter placement. Postoperative complications were compared between the two groups.

Results: The incidence of catheter displacement (p = 0.006) and omental wrapping (p = 0.034) demonstrated statistically significant differences between the two groups. However, the leakage, hernia, and early peritonitis occurrences were not statistically significant.

Conclusion: Low-site catheter placement combined with long-segment rectus abdominis embedding appears to offer advantages over conventional peritoneal dialysis catheter placement by reducing the risks of catheter displacement and omental wrapping. This technique may provide a more effective approach to peritoneal dialysis catheterization.

Introduction: Ascites management is crucial for gynecological cancer patients requiring long-term treatment. Cancer type-specific differences may influence CART outcomes, but comparative data remain limited. This study evaluated CART efficacy in gynecological versus other cancers.

Methods: This subgroup analysis included 125 cancer patients undergoing 296 CART sessions at 22 Japanese centers (2014-2015). Patients were divided into gynecological cancer (Group G, n = 46) and other cancer groups (Group O, n = 79).

Results: Group G had significantly higher concurrent chemotherapy rates (41.2% vs. 12.3%, p < 0.001) and ascitic protein/albumin concentrations. Group G showed significant renal function improvements: decreased serum creatinine (0.7 ± 0.3 to 0.6 ± 0.3 mg/dL, p < 0.001), decreased BUN (17.9 ± 8.7 to 14.5 ± 9.0 mg/dL, p < 0.001), and increased eGFR (72.7 ± 24.8 to 81.3 ± 27.6 mL/min/1.73 m², p < 0.001). Drainage intervals were longer in Group G (20.0 ± 13.8 vs. 11.7 ± 10.9 days, p < 0.001).

Conclusion: CART demonstrates enhanced efficacy in gynecological cancer patients, particularly improving renal function, potentially reducing chemotherapy-related toxicity, and improving treatment tolerability.