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

Background: Although donor lymphocyte infusion (DLI) is a treatment option after posttransplant immunomodulation, data on donor lymphocyte apheresis (DLA) remain scarce.

Methods: We retrospectively analyzed 26 recipients receiving DLI and their related donors (human leukocyte antigen [HLA]-matched, n = 9; haploidentical, n = 17).

Results: The median harvested CD3-positive cell count (CD3) was 6.71 × 10⁷ cells/kg (range, 3.55-19.74). A positive correlation was observed between harvested CD3 and preharvest lymphocyte counts (correlation coefficients = 0.78). In HLA-matched DLI, the median infused CD3 was 1.19 × 10⁷ per cycle and 4.56 × 10⁷ cells/kg in total; in haploidentical DLI, 0.25 × 10⁷ and 0.44 × 10⁷, respectively. The proportion of total infused CD3 relative to harvested CD3 was 26.3% (range, 2.7-100) in HLA-matched DLI and 4.5% (range, 1.4-26.0) in HLA-haploidentical DLI. [Correction added on 21 June 2025, after first online publication: The minimum and maximum value of range for infused CD3 proportion in HLA-matched DLI and HLA-haploindentical DLI has been corrected in this version.] CONCLUSIONS: Our findings reflect real-world practices and underscore the importance of tailoring DLA to donor and recipient characteristics, particularly in light of the increasing use of haploidentical donors.

Introduction: The Thailand Renal Replacement Therapy (TRT) Registry is a vital database tracking patient demographics, treatment modalities, and outcomes across hemodialysis centers nationwide.

Methods: This study analyzes TRT Registry data from 2000 to 2023 to identify trends and challenges in managing end-stage kidney disease (ESKD).

Results: Among 152 827 patients, 129 113 received hemodialysis, and 23 714 underwent peritoneal dialysis. Diabetic nephropathy and hypertension accounted for over 80% of cases, with IgA nephropathy as the most common biopsy-confirmed glomerulonephritis. Most patients had a primary school education or lower. The Universal Coverage Scheme (46.2%) was the primary funding source. Thrice-weekly dialysis was the most common regimen (65.0%), while 34.3% of patients received twice-weekly dialysis. Key challenges included anemia, malnutrition, vascular access issues, and disparities in dialysis adequacy. Cardiac disease (34.7%), infections (19.7%), and cerebrovascular disease (7.7%) were the leading causes of death.

Conclusion: Thailand's growing ESKD burden demands improved renal replacement therapy (RRT) strategies. The TRT Registry offers essential insights to guide policy and healthcare improvements.

Introduction: In the intensive care unit (ICU), plasmapheresis is used for critically ill patients, but data on plasma exchange practices, techniques, and indications in the ICU are limited. This study aims to describe the management of plasma exchange in the ICU at Clermont-Ferrand University Hospital.

Methods: This retrospective observational study analyzed patients who underwent therapeutic plasma exchange (TPE) via centrifugation or double filtration plasmapheresis (DFPP). Secondary analyses compared these techniques and their impact on in-hospital mortality.

Results: From 2011 to 2021, 196 patients received TPE. Common comorbidities included cardiovascular (42.3%), neurological (25.5%), and renal conditions (27.6%). Primary indications were thrombotic microangiopathies (25%), autoimmune neurological diseases (26%), and renal transplant rejection (18%). Centrifugation, the predominant technique, was used for critically ill patients, while DFPP was preferred for immune graft rejection and neurological diseases.

Conclusions: Selection bias likely influenced results, as technique choice depended on indication. The optimal approach for autoimmune neurological diseases remains unclear, warranting further investigation.

Objective: This study investigated the value of procalcitonin in the diagnosis of Gram-negative (G-) bacterial peritonitis associated with peritoneal dialysis.

Methods: A total of 195 patients were divided into the G- (55 cases) and G+ bacterial infection groups (140 cases). The data were compared between the two groups.

Results: The most common species in the G- group was Escherichia coli (16.92%) and in the G+ group was Staphylococcus epidermidis (28.21%). Women were more likely to develop G- bacteria-infected peritoneal dialysis-associated peritonitis (PDAP) compared to the G+ bacteria-infected group (P < 0.01). The procalcitonin (P < 0.001), C-reactive protein (CRP) (p = 0.005), and number of nucleated cells before treatment (P < 0.001) were significantly increased, while the absolute level of blood lymphocytes was decreased (p = 0.01) in the G- bacteria group. Multivariate logistic regression analysis revealed that female gender (P < 0.001), low absolute values of lymphocytes (p = 0.011), elevated procalcitonin (p = 0.038), elevated CRP (p = 0.008), and elevated number of nucleated cells before treatment (p = 0.002) were independent risk factors for G- bacteria-infected PDAP. The combination of the five indicators had the greatest predictive value for the occurrence of G- bacteria-infected PDAP with a ROC of 0.821 (P < 0.001).

Conclusion: An elevated serum PCT level, female gender, high number of nucleated cells before treatment, elevated serum CRP level, and low serum absolute lymphocyte number were independent risk factors for G- bacteria-infected PDAP.

Introduction: Acetic acid in dialysis fluid has been reported to induce symptomatic hypotension and post-dialysis fatigue. However, it remains unclear whether acetate-free dialysate improves these outcomes due to the lack of comprehensive evidence. This systematic review and meta-analysis aimed to compare the effects of acetate-free dialysate with standard acetate-containing dialysate using randomized controlled trials.

Method: We searched databases including MEDLINE, EMBASE, CENTRAL, and trial registries. Primary outcomes were fatigue, intradialytic hypotension (IDH), and all-cause mortality. Secondary outcomes included dropout rate due to adverse events, serum bicarbonate levels, and acid-base balance (pH) at the study's end. The Cochrane risk of bias tool 2 for crossover trials assessed the risk of bias, and we used a random effects model for meta-analyses, along with the GRADE approach to rate evidence certainty.

Results: We identified four randomized crossover trials involving 114 patients, all at high risk of bias due to period and carryover effects. The studies showed no significant impact on fatigue. Acetate-free dialysate may slightly reduce IDH (OR 0.83, 95% CI 0.66 to 1.04; I2 = 79%, across two studies with 5872 sessions) with low certainty of evidence. Results for secondary outcomes, including bicarbonate levels and pH, were inconclusive due to very low certainty of evidence.

Conclusion: In conclusion, no clear benefit was observed for acetate-free dialysate compared with dialysate containing low concentrations of acetate. Further studies are needed to definitively ascertain the benefits of low-acetate dialysates in hemodialysis treatment.