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: The elimination of myelin oligodendrocyte glycoprotein (MOG) antibodies using immunoadsorption (IA) is a therapeutic approach, but has not yet been specifically evaluated in MOG antibody-associated disease (MOGAD). This study aimed to provide evidence on the efficacy and safety of IA therapy for MOGAD.

Methods: This retrospective study included patients diagnosed with MOGAD, who were treated with IA. Clinical data of the patients were collected. The extended disability score scale (EDSS) before and after IA therapy was used to evaluate neurological status.

Results: Six patients aged 14-53 years were enrolled in this study. Each patient received 3-7 sessions of IA therapy. Half of the patients showed significant clinical improvement after IA, with EDSS scores decreasing by more than 1.0, whereas the other patients were unresponsive to IA. Partial remission of visual acuity was obtained in three of the four patients with visual impairment. Repeated detection of MOG antibodies in one case showed that the titer declined from 1:100 to 1:32 after five sessions of IA. Only one episode of mild hypotension was observed in 29 IA sessions.

Conclusion: IA therapy may be a potential treatment option for patients with MOGAD.

Introduction: This study evaluated the reliability, quality, and readability of ChatGPT (OpenAI, San Francisco, CA), Gemini (Google, Mountain View, CA), and Copilot (Microsoft Corp., Washington, DC) which are among the most widely used large language models (LLMs) today in answering frequently asked questions (FAQs) related to pediatric dialysis.

Methods: A total of 45 FAQs were entered into LLM. The Modified DISCERN (mDISCERN) scale assessed reliability; the Global Quality Score (GQS) evaluated quality; and readability was assessed using five metrics: Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), Gunning Fog Index (GFI), Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL). Questions were directed to the chat robots twice, on January 25, 2025, and February 1, 2025.

Results: All three chatbots displayed high reliability, achieving median mDISCERN scores of 5. Quality scores on the GQS were similarly high, with median scores of 5 across platforms; however, Gemini exhibited greater variability (range 1-5) compared to ChatGPT-4o and Copilot (ranges 3-5). Readability scores revealed that chatbot responses were written at an advanced level.

Conclusion: This study found that LLMs responses to dialysis FAQs were reliable and high quality, but difficult to read; improving readability through expert-reviewed content could increase their impact on public health.

Purpose: Chronic kidney disease (CKD) poses a significant public health challenge, severely affecting patients' quality of life. The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend discussing renal replacement therapy options when patients reach CKD stage 4. Arteriovenous fistula (AVF) creation is considered the gold standard for vascular access in hemodialysis. This retrospective study aims to evaluate whether any changes in kidney function occur during the follow-up period after AVF creation in patients with end-stage kidney disease (ESKD).

Methods: We analyzed data from 60 CKD patients who underwent AVF creation and were monitored in our nephrology outpatient clinics. Seventeen patients who consistently attended follow-up visits were included for detailed analysis. We performed a retrospective review of laboratory and medical records from 6 months before and 6 months following AVF creation.

Results: The cohort comprised 41.2% males, with a mean age of 62.4 years. The predominant underlying conditions were diabetes mellitus (58.8%), hypertension (29.4%), and polycystic kidney disease (11.8%). Statistical analysis of laboratory values before and after AVF creation (at 1, 3, and 6 months) revealed a significant decline in estimated glomerular filtration rate (eGFR) before AVF placement, followed by stabilization in the subsequent 6 months.

Conclusion: The rate of eGFR decline was significantly reduced in CKD patients with AVF. This may be attributed to increased awareness of impending hemodialysis, leading to better dietary adherence and treatment compliance.

Introduction: Regional citrate anticoagulation (RCA) is highly recommended as an anticoagulation method for intermittent hemodialysis (IHD) in patients at high bleeding risk. Few studies have investigated the effect of ionized calcium (iCa) concentration at different pipeline points on circuit clotting in RCA using calcium-containing dialysate.

Methods: This prospective study included 185 IHD sessions treated with a two-stage RCA protocol. Ionized calcium levels were measured at different pipeline points. The primary endpoint was severe clotting in the extracorporeal circulation circuit (ECC).

Results: Sessions with severe circuit clotting showed higher platelet counts, shorter activated partial thromboplastin time, greater dialyzer surface areas, and higher iCa concentrations around venous bubble trap (VBT). Cox regression models revealed that iCa concentration before VBT (per 0.10 mmol/L, hazard ratio (HR) = 1.54, p = 0.006) and baseline platelet count (HR = 1.01, p = 0.02) were strongly associated with severe circuit clotting.

Conclusion: The iCa concentration before VBT could serve as a key indicator of anticoagulant efficacy in RCA with calcium-containing dialysate.

Introduction: The efficacy of peritoneal lavage monotherapy using PD solution for severe peritonitis remains unproven.

Methods: We evaluated the effects of 3-times and 6-times lavage using low GDP neutral PD solution on a Methicillin-sensitive Staphylococcus aureus (MSSA) lethal peritonitis model rats without antibiotic use. Changes in effluent viable bacteria numbers dependent on lavage frequency were determined in a further 10 rats.

Results: Compared to the lethal peritonitis model without lavage, both 3-times and 6-times lavage significantly reduced 24-h mortality, effluent FDP and creatinine concentrations. Furthermore, 6-times lavage significantly prevented the rough fur development, intraabdominal adhesion, and pus formation which developed in both the 0-times and 3-times lavage groups. The effluent viable bacterial counts showed significant step-ladder decreases with an increasing number of the lavages.

Conclusion: We demonstrated for the first time that lavage monotherapy using PD solution reduces mortality and severity in a lethal peritonitis model by rapidly eliminating bacteria without antibiotic use.

The main treatment for end-stage renal disease (ESRD) is renal replacement therapy, among which peritoneal dialysis (PD) is easy to perform, inexpensive, and widely used. The internationally adopted Peritoneal Equilibration Test (PET) categorizes peritoneal function into four types based on the dialysate-to-plasma creatinine ratio (D/Pcr). In some patients undergoing long-term PD, changes in peritoneal function lead to a decline in dialysis adequacy, which ultimately results in withdrawal from PD. Among these patients, those with high-transport peritoneal function exhibit higher mortality rates and poorer prognoses compared to patients with low-transport peritoneal function. However, PET fails to identify underlying pathologies (e.g., fibrosis, inflammation). Similarly, dialysis adequacy tests also fail to reveal the underlying causes of changes in dialysis adequacy. Therefore, early identification of the underlying causes of peritoneal function changes and timely clinical interventions may prolong the duration of PD. This review lists biomarkers related to peritoneal transport function that may indicate the causes of altered peritoneal function and could guide clinical treatment protocols in the future.