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: Functional decline occurs during dialysis initiation, particularly in unplanned cases. To prevent unplanned hemodialysis, we aimed to identify associated factors from the first referral to the nephrology department to hemodialysis initiation and assess patient prognosis post-unplanned hemodialysis initiation.

Methods: This retrospective study involved 257 Japanese patients initiating hemodialysis and compared patient characteristics based on whether hemodialysis was planned or unplanned at a single center. Patient outcomes were evaluated in collaboration with maintenance hemodialysis centers.

Results: Unplanned hemodialysis initiation correlated with heart failure history (p < 0.05) and infections like pneumonia (p < 0.001). Patients with unplanned hemodialysis initiation had a worse prognosis than those with planned initiation (p < 0.001), and multivariable Cox regression showed it as an independent risk factor for death (p < 0.05).

Conclusions: Hygiene and careful attention to heart failure may reduce unplanned hemodialysis and improve patient well-being and healthcare efficiency. This retrospective analysis highlights crucial considerations for optimizing the initiation of hemodialysis.

Double filtration plasmapheresis (DFPP) is a semi-selective blood purification modality derived from the plasma exchange modality. DFPP can be applied to a variety of refractory disorders including metabolic disorders, organ transplants, rheumatic disorders, neurological disorders, and dermatologic disorders. Familial hypercholesterolemia and lipoprotein (a) hyperlipoproteinemia are major chronic metabolic disorders. Lipoprotein apheresis (LA) is applied for those patients to remove low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) (Lp(a)). DFPP is used as one of the modalities in LA. In addition to removing LDL-C and Lp(a), DFPP has pleiotropic effects such as removal of lipid metabolism-related substances, C-reactive protein lowering effect, removal of adhesion molecules, removal of inflammatory cytokines, and anti-oxidative effect. This article summarizes the pleiotropic effects of DFPP based on recent clinical articles.

Introduction: This is a phenomenologically designed qualitative study conducted to explore and conceptualize the problems experienced by intensive care nurses caring for patients undergoing continuous renal replacement therapy.

Methods: Face-to-face, semi-structured interviews were conducted with the participants. The interviews were transcribed verbatim, then thematic analysis was conducted.

Results: The study was conducted 12 intensive care nurses. As a result, 3 main and 6 sub-themes were identified. The themes identified were changing routines, uncertainty in terms of patient benefit, and need for adaptation.

Conclusion: It was found that nurses experienced challenges in providing care to patients undergoing continuous renal replacement therapy, spent more effort to prevent complications, and lacked information on the subject. It is recommended to consider institutional and individual actions to meet the educational needs of nurses for implementing continuous renal replacement therapy.

Introduction: Therapeutic plasma exchange (TPE) eliminates disease-contributing substances but may also affect drug concentrations. This study aimed to assess the prevalence of prescription drugs removable via TPE by reviewing patient medication histories.

Methods: A retrospective, single-center study was conducted from January 1, 2021 to December 31, 2022. The study included 244 patients undergoing 1087 TPE sessions. Drugs prescribed to patients on TPE days were categorized as "yes" (probably removable), "maybe" (possibly removable), and "no" (unlikely removable) regarding their removability via TPE.

Results: Among 3966 prescriptions, 556 (14.0%) were analyzed, with 21.8%, 36.5%, and 41.7% falling into the "yes," "maybe," and "no" categories for removability. Although only 14.0% were categorized, 83.6% of patients received at least one analyzable drug. Among them, 83.8% had at least one potentially removable drug.

Conclusion: Real-world data highlights the need for caution in drug treatments during TPE to ensure optimal therapeutic outcomes, particularly for specific drugs.

Introduction: Peritoneal dialysis (PD) is a mode of therapy in which the patients themselves actively participate in the care of their own disease. We examined a possible association of salt reduction before starting dialysis with PD technique survival.

Methods: This retrospective cohort study included 42 patients who started PD between April 2014 and March 2018. Participants were allocated to two groups based on their estimated daily salt intake before the initiation of dialysis: patients with an estimated daily salt intake <6 g/day were allocated to the appropriate salt intake group (AS group), while the rest were assigned to the high salt intake group (HS group).

Results: During a median follow-up of 47 months, PD technique survival, defined by death or transition to hemodialysis, was significantly lower in the HS group compared to the AS group.

Conclusion: Successful salt reduction before dialysis introduction is associated with better PD technique survival.

Introduction: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are markers of systemic inflammatory status. The relationship between NLR, PLR, and mortality is controversial among hemodialysis (HD) patients.

Objective: Evaluate NLR and PLR in the prediction of mortality in chronic HD patients.

Materials and methods: We analyzed 130 patients with a follow-up for 66 months. Four groups were established according to NLR-PLR values. Kaplan-Meier curves and Cox proportional hazards analysis were used.

Results: NLR-PLR correlated positively with C-reactive protein. Cox regression analysis for overall mortality among the four groups included age (HR 1.027, 95% CI 1.003-1.053) and albumin (HR 0.25, 95% CI 0.073-0.85). For cardiovascular (CV) mortality only pulse pressure differential (PPD) was included (HR 1.033; 95% CI 1.014-1.052). Low NLRs and high PLRs were associated with CV mortality (Log Rank test, p = 0.033).

Conclusions: Low NLRs and high PLRs predict the risk of CV mortality among HD patients.

Introduction: This study aims to investigate patient factors affecting the rate of plasma volume target attained in hypertriglyceridemic pancreatitis (HTG-AP) patients undergoing double filtration plasmapheresis (DFPP).

Methods: A retrospective analysis of 82 HTG-AP-interpreted patients from January 2019 to April 2024 compared target plasma volume treated between up-to-scratch and non-scratch groups. The group comparison used independent samples t-test, Mann-Whitney U-test, and chi-square test. Binary logistic regression was used to identify independent risk factors for patients' plasma volume target failure. The ROC curve assessed these risk factors' diagnostic efficacy.

Results: Of 82 patients, 52 were classified as belonging to the up-to-scratch group, while the remaining 30 were classified as belonging to the non-to-scratch group. Statistically significant differences were seen between the groups regarding admission heart rate, triglyceride, calcitonin gene, C-reactive protein, D-dimer, and fibrinogen (FIB) levels (p <0.05). The binary logistic regression analysis showed that for every 1 mmol/L increase in triglycerides (TG), the probability of experiencing substandard target plasma handling increased by 5.0% (OR = 1.05, 95%CI 1.01-1.08, p = 0.009). Furthermore, for each g/L rise in FIB, there was a 74% increase in the likelihood of encountering suboptimal target plasma handling (OR = 1.74, 95%CI 1.18-2.56, p = 0.005). The ROC curve study revealed that the AUC for TG was 0.67, for FIB was 0.77, and for the combination of both markers was 0.80; all the p values were below 0.05.

Conclusion: The increased levels of TG and FIB are independent risk factors affecting the target plasma handling achievement rate in HTG-AP patients undergoing DFPP.