INTRODUCTION:Arterial stiffness, a hallmark of vascular aging. It may link chronic kidney disease (CKD) to frailty and functional decline. This study aimed to evaluate the associations between arterial stiffness and geriatric syndromes. METHODS:Individuals aged ≥ 60 years; 90 patients with stage 3b-5 CKD or receiving dialysis, and 90 age-matched healthy controls were included. Arterial stiffness was assessed using Pulse Wave Velocity (aPWV). Geriatric assessments for frailty, malnutrition, depression, polypharmacy, and dependence in daily living were evaluated. Multivariable regression was used to identify possible predictors for arterial stiffness. RESULTS:aPWV was higher in the CKD group than in controls. Frailty, malnutrition, and depression were not associated with arterial stiffness in CKD patients. Arterial stiffness was significantly associated with increased dependency. However, age and systolic blood pressure seem to be major determinants for aPWV. CONCLUSION:aPWV is elevated in older adults with CKD, and it may reflect functional dependence.
INTRODUCTION:This study investigated the safety and efficacy of single-needle Rheocarna therapy for chronic limb-threatening ischemia (CLTI) with wounds. METHODS:Six patients with CLTI involving ulcers unresponsive to revascularization underwent single-needle Rheocarna treatment. Changes in mean low-density lipoprotein cholesterol (LDL-C), fibrinogen, C-reactive protein (CRP), white blood cell (WBC) count, platelet count, blood flow, and wound improvement were compared between treatment initiation and completion. RESULTS:The treatment never required discontinuation due to in-circuit coagulation or hypotension, and its safety was confirmed. After 10 treatment sessions, LDL-C and fibrinogen removal rates were 24.3% and 24.4%, respectively. Platelet, WBC, and CRP values did not change significantly over time. Blood flow increased during treatment and posttreatment. All patients experienced wound improvement and favorable clinical outcomes. CONCLUSION:Single-needle Rheocarna therapy is effective for wound healing in CLTI. If this method applies to nondialysis patients without arteriovenous fistulas, indications for Rheocarna therapy will likely expand.
BACKGROUND:Therapeutic plasma exchange (TPE) is widely used for autoimmune diseases; however, current modalities involve trade-offs between molecular selectivity and vascular access requirements. We developed a novel hybrid modality, centrifugation selective plasma exchange (cSePE), combining centrifugal plasma separation with membrane-based plasma fractionation. METHODS:Seven patients with autoimmune diseases underwent cSePE (15 sessions) between April 2024 and June 2025. Solute concentrations before and after treatment were measured, and hematocrit-adjusted removal ratios (RRs) were calculated. RESULTS:The mean RR of IgG was 65.7% ± 11.1%, while fibrinogen reduction was limited to 29.8% ± 9.9%. Disease-specific autoantibodies showed RRs exceeding 45%. Serum albumin levels remained unchanged. No treatment-related complications were observed. CONCLUSIONS:cSePE enables selective removal of IgG fractions while preserving high-molecular-weight proteins and can be performed via peripheral venous access. This modality may represent a promising new option for plasma exchange in autoimmune diseases.
BACKGROUND:Anti-glomerular basement membrane (anti-GBM) disease complicated by thrombotic microangiopathy (TMA) is rare and clinically challenging. In the setting of severe infection and active autoimmune disease, complement activation may reflect a secondary process rather than primary atypical hemolytic uremic syndrome (aHUS). Therapeutic plasma exchange (TPE) is standard therapy for anti-GBM disease, but alternative antibody removal strategies are required when TPE is not tolerated. CASE PRESENTATION:We describe a 46-year-old female with anti-GBM disease who developed TMA with preserved ADAMTS13 activity (72.04%) and 2.3% schistocytes on peripheral smear. Soluble C5b-9 was elevated in the context of severe concurrent infection. TPE was discontinued due to intolerance (oxygen desaturation, fever, and dizziness). Seven sessions of protein A immunoadsorption (PAIA) were performed for selective antibody removal, and anti-GBM antibody levels decreased from > 400 to 20.80 RU/mL during treatment. Eculizumab was administered on Days 7, 14, and 30, for persistent complement activation. Hematologic and biochemical parameters stabilized and gradually improved during combined therapy. CONCLUSION:This case suggests that PAIA may represent a feasible alternative antibody removal strategy in anti-GBM disease intolerant to plasma exchange. In selected cases of secondary complement-mediated TMA with ongoing complement activation, short-term complement inhibition may contribute to disease stabilization; however, a definitive causal relationship cannot be established in a single case.
INTRODUCTION:Patients requiring long-term continuous renal replacement therapy (CRRT) generally have poor prognoses. This study evaluated whether adding continuous intravenous sodium infusion (cIVNa) is associated with improved hemodynamics and outcomes in patients undergoing long-term CRRT for ≥ 7 days. METHODS:This secondary analysis included 46 patients with acute kidney injury who required ≥ 7 days of CRRT from a previously published cohort. Patients received either conventional CRRT (n = 24) or CRRT plus cIVNa (n = 22). Hemodynamic parameters, fluid balance, laboratory findings, and clinical outcomes were compared. RESULTS:cIVNa group exhibited more stable hemodynamics, higher urine output, and a more favorable fluid balance. Rates of 90-day survival without renal replacement therapy (RRT) (42.9% vs. 12.5%, p < 0.05), survival to ICU discharge (68.2% vs. 29.2%, p < 0.05), and CRRT/RRT withdrawal were significantly higher among patients receiving cIVNa than among those receiving conventional CRRT. CONCLUSION:cIVNa may support hemodynamic stability and improve RRT withdrawal and survival outcomes in patients requiring long-term CRRT.
PURPOSE:A checklist is an effective tool for ensuring patient safety. We have already been using a briefing checklist for hemodialysis. However, we did not have ones for apheresis therapy. From the experiences of incidents that occurred in February and March 2024. We decided to create a briefing checklist for apheresis therapy, especially for plasma exchange (PE) and double filtration plasmapheresis (DFPP). METHODS:First, we made a briefing checklist specific to apheresis therapies, different from hemodialysis. Another incident occurred 6 months later, revealing that staff used the checklist in a manner different from the intended one. The fact prompted us to revise the apheresis therapy checklist, with items and the order of appearance similar to those of the hemodialysis checklist. We also provided detailed explanations of apheresis therapy for clinical engineers unfamiliar with it. We have not experienced any incident since September 2024, when the revised procedures were implemented, until May 2025. CONCLUSION:The briefing checklist provided benefits, including improved patient safety and education for clinical engineers unfamiliar with apheresis. the revision process further improved the checklist's efficiency.
INTRODUCTION:Patients receiving hemodialysis frequently experience anxiety and treatment non-adherence, which negatively impact clinical outcomes. Digital health interventions offer innovative opportunities to address these challenges during dialysis sessions. METHODS:This cluster-randomized controlled trial included 40 patients receiving chronic hemodialysis (intervention n = 20, control n = 20). The intervention group played a story-based digital game once during hemodialysis; controls received standard care. Outcomes were assessed using validated scales for anxiety, adherence, and dietary knowledge at baseline, 2 weeks, and 1 month. RESULTS:The intervention group demonstrated significant improvements in treatment adherence (p < 0.001), dietary knowledge (p = 0.002), and anxiety reduction (p < 0.001) compared with controls at both follow-ups. Participants reported high game engagement with minimal negative effects. No adverse events occurred. CONCLUSIONS:A single-session story-based digital game enhanced adherence, knowledge, and reduced anxiety in hemodialysis patients, demonstrating that brief, engaging digital tools can support dialysis care and promote behavioral change.
INTRODUCTION:Among vulnerable dialysis patients, initial symptom duration of coronavirus disease 2019 (COVID-19) has not been investigated extensively. METHODS:We analyzed 153 dialysis patients with COVID-19 in a long-term care hospital between February 2022 and August 2023. We investigated the association between the delayed resolution of the initial symptoms (≥ 6 days), including fever or upper respiratory symptoms, and worse outcomes. These outcomes were defined as either a decrease in the Geriatric Nutritional Risk Index of ≥ 3.6% at 3 months after onset, or all-cause death within 3 months. RESULTS:The duration of the initial symptoms was associated with worse outcomes. This association remained significant after adjustment for patient background, COVID-19 severity, C-reactive protein levels at onset, vaccination, and antiviral therapy, using multivariate analysis. CONCLUSION:The duration of the initial symptoms may be a useful indicator for predicting the poor prognosis, including nutritional deterioration after COVID-19, among vulnerable dialysis patients.
BACKGROUND AND AIMS:End-stage renal disease (ESRD) patients who undergo hemodialysis treatment experience accelerated atherosclerosis development, which results from two main causes: atherogenic dyslipidemia and chronic inflammation. The NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, which serves as an essential innate immunity regulator, has links to cardiovascular disease development; yet researchers have not effectively studied its connection to atherogenic lipid profiles among dialysis patients. This study examined the association between NLRP3 inflammasome levels and the atherogenic index of plasma (AIP) in hemodialysis patients. METHODS:This study at Mansoura University Hospital focused on adults with ESRD or chronic kidney disease (CKD) stage 5 undergoing hemodialysis. Participants over 18 years attended three sessions weekly, with exclusions for pregnant individuals, previous kidney transplant patients, those on different dialysis methods, active infection sufferers, and recent medication users. The research measured serum NLRP3 inflammasome levels, hematological parameters, and lipid profiles, calculating the AIP. Sequential multivariable linear regression sensitivity models with bootstrapping examined the association between NLRP3 levels and the atherogenic index, while ensuring accuracy by checking for multicollinearity using variance inflation factors (VIFs). RESULTS:Of 44 hemodialysis patients (median age 49 years, 57% female, 75% hypertensive), NLRP3 inflammasome levels showed wide variation (median 168.7 ng/L, IQR: 76.6-404.6), alongside atherogenic dyslipidemia marked by elevated indices: AIP 0.04 (-0.14 to 0.34), Castelli I 3.42 (3.01-4.61), remnant cholesterol 0.54 mmol/L (0.39-0.84), and atherogenic coefficient 2.42 (2.01-3.61), with lipids including TG 1.18 mmol/L (0.85-1.82), HDL-C 1.08 (0.92-1.21), LDL-C 2.14 (1.62-2.89). Sequential multivariable linear regression sensitivity models with bootstrapping revealed NLRP3 levels significantly associated with AIP (unadjusted B = 0.001, p < 0.001; age and gender-adjusted B = 0.001, p = 0.002; adjusted for smoking/uric acid/LDL-C/SBP B = 0.001, p = 0.016), robust via bootstrapping (2000 iterations, VIF < 1.5, no multicollinearity). Dialysis adequacy was good (K t/V 1.48, urea reduction ratio [URR] 66.3%), with hypertensive nephropathy predominant (38.6%); complications like intradialytic hypotension (38.6%) were common. Metabolic syndrome affected 50%. Findings suggest NLRP3 inflammasome levels are associated with atherogenic dyslipidemia in maintenance hemodialysis patients. Further longitudinal studies are needed to determine causal relationships and whether NLRP3 inhibition could reduce cardiovascular risk in this population. CONCLUSIONS:In this exploratory single-center study, circulating NLRP3 levels were associated with AIP-defined atherogenic lipid abnormalities in maintenance hemodialysis patients. These findings support further prospective and mechanistic studies to clarify temporality, pathway specificity, and clinical relevance.
Introduction Bloodstream infections due to repeated vascular access (VA) puncture and circuit connections remain major concerns in hemodialysis. Therefore, we examined current practices for glove, disinfectant, and personal protective equipment (PPE) use according to VA type in national university hospitals in Japan.Methods Two questionnaire surveys were conducted between 2019 and 2022, with responses obtained from all 42 hospitals.Results All facilities used disposable gloves for cannulation and VA connection. Nonsterile gloves were more frequently used than sterile gloves for arteriovenous fistula (AVF), arteriovenous graft (AVG), subcutaneously fixed superficial artery, noncuffed catheters, and cuffed catheters. In 2019, nonsterile gloves were reported in 67% of facilities for AVF, 60% for AVG, 71% for subcutaneously fixed superficial arteries, 74% for noncuffed catheters, and 73% for cuffed catheters. In 2022, rates were 81%, 60%, 67%, 64%, and 67%, respectively. Disinfectant selection differed by VA type. In 2019, chlorhexidine gluconate (CHG) was most commonly used for AVF, povidone-iodine (PI) for AVG and subcutaneously fixed superficial arteries, and alcohol for both noncuffed and cuffed catheters. In 2022, CHG-alcohol predominated for AVF, while PI remained a common disinfectant for AVG and subcutaneously fixed superficial arteries. PPE use increased from the first to the second survey.Conclusions Infection control practices during VA cannulation and connection varied even among national university hospitals. Further studies evaluating associations with infection outcomes are needed.
Introduction This multicenter cross-sectional study evaluated fear of COVID-19 after vaccination and the association between multidimensional health literacy (HL) and fear in patients undergoing hemodialysis.Methods COVID-19 fear scores were compared with those of adults in April 2020 using an unpaired t-test. The association between multidimensional HL and COVID-19 fear scores was estimated using a multivariable-adjusted general linear model.Results A total of 446 patients were analyzed, of whom 431 (97%) and 9 (2%) received three and two vaccination doses, respectively. Participants' COVID-19 fear scores were significantly lower than those of the general population at the beginning of the pandemic. Higher functional HL was associated with lower fear, whereas higher critical HL was associated with greater fear. Communicative HL was not associated with fear.Conclusion Fear of COVID-19 among patients with low-functional HL could be reduced by providing health information in an easy-to-understand manner.
BACKGROUND:Patients with chronic kidney failure often experience reduced physical function due to inactivity and arteriovenous fistula-related complications, negatively affecting quality of life. This study aimed to investigate the effect of intradialytic exercise on functional capacity, quality of life, fatigue, and depression in hemodialysis patients. METHODS:This was a prospective, randomized controlled trial including 72 hemodialysis patients (aged 18-80 years) undergoing treatment three times per week for at least 1 year. Participants were randomly assigned to an exercise group (mean age: 55.7 ± 12.0 years) or a control group (mean age: 54.6 ± 14.2 years). The exercise group performed supervised combined aerobic and resistance exercises during dialysis sessions, three times weekly for 8 weeks, while the control group received routine hemodialysis care. Outcomes were assessed at baseline and after 8 weeks using the Six-Minute Walk Test, Five-Repetition Sit-to-Stand Test, Kidney Disease Quality of Life-36 questionnaire, Visual Analog Scale for fatigue, Beck Depression Inventory. RESULTS:Fifty-nine patients completed the study (exercise group: n = 30; control group: n = 29). Both groups were similar at baseline. Post-intervention, the exercise group demonstrated significant improvements in physical performance (p = 0.046), quality of life subdomains (p < 0.05), and depression (p < 0.001), whereas no significant change was observed in functional capacity (p = 0.627) or fatigue (p = 0.537). In contrast, the control group demonstrated declines in several quality of life subdomains (p < 0.05), with significant worsening in fatigue (p = 0.011) and depression (p = 0.011). CONCLUSIONS:Intradialytic exercise is an effective intervention to improve physical and psychological outcomes in hemodialysis patients, suggesting its integration into routine dialysis care may help mitigate progressive functional decline. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05246956.
OBJECTIVE:Apheresis is a medical procedure used to remove harmful blood components across different disciplines. This bibliometric analysis evaluated the scientific characteristics of the 100 most-cited articles (T100) with the term "apheresis" in the title published between 1975 and 2025. MATERIALS AND METHODS:Data were retrieved from the Web of Science on August 11, 2025, using the keyword "apheresis" in the title field. Among 5765 publications, the T100 articles were identified. Recorded parameters included title, corresponding author, journal, year, total citations, number of authors, adjusted citation index (ACI), and Altmetric score (AmS). Analyses were performed with SPSS 29.0 and VOSviewer. RESULTS:Publication output increased over time, peaking in 2017 (n = 227). The highest number of annual citations occurred in 2024 (n = 2944). Spearman's correlation demonstrated a significant positive relationship between ACI and AmS (r s = 0.665, p < 0.001). The Journal of Clinical Apheresis contributed the largest share of T100 articles. The United States was the most productive country (30%), while no Turkish publications were included. Schwartz J. was the most cited author, with 2653 citations across five studies. Frequently used keywords were "apheresis" (16%), "plasma exchange" (9%), and "immunoadsorption" (8%). CONCLUSION:Apheresis research exhibits a dynamic, multidisciplinary structure, with citations peaking years after publication. High-income countries and central institutions dominate scientific output, while contributions from Turkey are absent in the T100. This study highlights key research trends and provides a reference point for future investigations in apheresis.
OBJECTIVE:To compare the efficacy and safety of roxarestat versus recombinant human erythropoietin (rhEPO) in the management of renal anemia in patients undergoing maintenance hemodialysis. METHODS:This was a prospective, open-label, randomized controlled trial. A total of 240 patients were randomly assigned to receive either oral roxarestat (n = 120) or subcutaneous rhEPO (n = 120) for 6 months. The target hemoglobin (Hb) range was set at 110-130 g/L for both groups, and dose adjustments were permitted based on Hb levels during follow-up. The primary endpoint was the change in Hb level from baseline to 6 months. Secondary endpoints included changes in red blood cell (RBC) count, hematocrit (Hct), iron metabolism parameters (serum ferritin [SF], serum iron [SI], hepcidin [Hepc], transferrin [TRF], total iron binding capacity [TIBC]), inflammatory markers (tumor necrosis factor-α [TNF-α], interleukin-1β [IL-1β], interleukin-6 [IL-6]), quality of life scores (Kidney Disease Quality of Life-36 [KDQOL-36]), and the incidence of adverse events. RESULTS:After 6 months, Hb increased from 82.13 ± 27.43 g/L to 101.3 ± 10.34 g/L in the rhEPO group and from 83.60 ± 8.29 g/L to 110.6 ± 11.00 g/L in the roxarestat group. The increase in Hb was significantly greater in the roxarestat group (mean difference 9.30 g/L, 95% CI 6.45-12.15, p < 0.001). Similarly, RBC and Hct levels were also significantly higher in the roxarestat group compared with the rhEPO group (p < 0.05 for both). Improvements in iron metabolism parameters and reductions in inflammatory markers were more pronounced in the roxarestat group. Quality of life scores improved in both groups, with significantly higher scores in the roxarestat group in all KDQOL-36 subscales (p < 0.05). The incidence of adverse events was 20.83% in the roxarestat group and 16.67% in the rhEPO group, with no statistically significant difference (p = 0.226). CONCLUSION:Roxarestat was more effective than rhEPO in increasing hemoglobin levels and other anemia-related parameters in maintenance hemodialysis patients, with comparable safety. The findings suggest that roxarestat may offer advantages in iron metabolism modulation and inflammation reduction, contributing to improved quality of life.
BACKGROUND:Therapeutic plasma exchange (TPE) is a cornerstone of therapeutic apheresis across multiple subspecialties. While international registries have described global practice, nationwide data from Thailand are lacking. METHODS:We conducted a 10-year retrospective analysis of all TPE admissions reimbursed under Thailand's Universal Health Coverage scheme (2014-2023). Cases were identified using ICD-9 code 997.1. Demographics, clinical indications, complications, outcomes, and costs were extracted from discharge records. Indications were categorized according to the 2023 American Society for Apheresis (ASFA) guidelines. RESULTS:A total of 5884 admissions were identified. The mean age was 46.4 ± 20.6 years, 58.0% were male, and 13.0% were pediatric. TPE Utilization increased from the mid-200s in 2014 to nearly 900 admissions in 2023. Neurological (28.9%) and nephrological (24.4%) disorders were the leading subspecialties. Systemic lupus erythematosus (12.4%), septic shock (12.1%), and acute inflammatory demyelinating polyradiculoneuropathy (9.1%) were the most frequent disease-specific indications. Nearly three-quarters of procedures were guideline-supported (Category I: 28.6%, Category II: 31.7%), while Category III use was 28.1% in our cohort. In-hospital mortality was 51.6% overall, driven largely by septic shock and acute liver failure, whereas survival exceeded 70% in autoimmune neurologic diseases and transplant recipients. Complications included bleeding (25.5%), transfusion requirements (69.0%), and hypocalcemia (9.7%). The actual cost per admission ranged USD 4000-12000, while reimbursement covered USD 2000-7000. CONCLUSION:This first nationwide analysis of TPE in Thailand highlights increasing utilization, high-cost burden, and important differences from global practice. Strengthening registries, refining coding systems, and developing region-specific guidelines will be critical to optimize outcomes and sustainability.
BACKGROUND:Therapeutic plasma exchange (TPE) removes circulating pathogenic antibodies, immune complexes, cytokines, and complement components. While established in adult neurology, evidence on its safety and efficacy in pediatric neurocritical care remains limited. OBJECTIVE:To evaluate the indications, clinical efficacy, and safety of TPE in children with acute or subacute immune-mediated neurological disorders admitted to the pediatric intensive care unit (PICU). METHODS:A retrospective cohort of 24 pediatric patients (aged 1-18 years) treated with TPE between February 2023 and October 2025 was analyzed. Diagnoses included multiple sclerosis (n = 8), Guillain-Barré syndrome (n = 5), acute disseminated encephalomyelitis (n = 3), transverse myelitis (n = 3), autoimmune encephalitis (n = 3), optic neuritis (n = 1), and myasthenia gravis (n = 1). Patients received 3-7 TPE sessions. Clinical response was measured using the modified Rankin Scale (mRS) and GBS disability scores before and after treatment. RESULTS:A total of 130 sessions were performed. Clinical improvement occurred in 20 of 24 patients (83%)-moderate in 8 (33%) and mild in 12 (50%). Median mRS/GBS scores decreased from 4.0 to 3.0 (p = 0.001). Early initiation of TPE (≤ 7 days from symptom onset) was associated with a higher likelihood of neurological improvement in multivariable analysis. No life-threatening complications were observed. Transient, reversible events included hypocalcemia (2.3%), hypotension (1.5%), and urticaria (1.6%). CONCLUSION:TPE appears to be a safe and potentially beneficial intervention for severe or refractory pediatric neuroimmunological disorders. Earlier initiation of TPE was associated with improved neurological outcomes; however, these findings should be interpreted cautiously given the small sample size and heterogeneous disease groups. These findings support integrating TPE into multidisciplinary PICU management and add to the growing evidence supporting its use in pediatric neuroimmunology.
INTRODUCTION:To evaluate the indications, clinical outcomes, and predictors of mortality associated with therapeutic plasma exchange (TPE) in critically ill pediatric patients. METHODS:A retrospective study including all critically ill children (1 month-18 years) who underwent TPE in a tertiary 30-bed PICU between January 2023 and November 2025. Data collected included demographics, ASFA 2023-based indications, extracorporeal therapy use, complications, and mortality. Primary outcome was PICU mortality; secondary outcomes included complications and predictors of death. RESULTS:Eighty-three patients underwent 242 TPE sessions (median: 3 [IQR 2-4]). The leading indication was sepsis/multiple organ dysfunction syndrome (MODS) (65.1%), followed by neurologic (9.6%) and renal (8.4%) diseases. According to the American Society for Apheresis (ASFA) 2023 guidelines, 81.9% of indications were categorized as Category III. TPE was combined with continuous renal replacement therapy (CRRT) in 19.3% and with extracorporeal membrane oxygenation (ECMO) in 3.6% of patients. Overall mortality was 26.5%, with the highest mortality observed in hematologic and rheumatologic groups (50% each). Higher Pediatric Risk of Mortality (PRISM) scores, higher PELOD-2 scores, elevated Vasoactive-Inotropic Scores (VIS), and the need for ECMO were independent predictors of mortality (p < 0.05). Both CRP and procalcitonin levels decreased significantly following TPE (p < 0.001), with a more pronounced reduction in survivors. TPE-related complications occurred in 47%, most commonly hypotension (21.7%), hypocalcemia (9.6%), allergic reactions (9.6%), and circuit clotting (6.0%), with no procedure-related deaths. CONCLUSION:TPE is feasible and generally safe in critically ill children. Outcomes are primarily influenced by illness severity-particularly high PRISM scores and ECMO requirement-rather than TPE-specific factors. Given the predominance of Category III indications, prospective multicenter studies are needed to refine pediatric TPE criteria, optimal timing, and patient selection.
INTRODUCTION:Peritoneal dialysis (PD) patients lose protein in their waste dialysate, potentially increasing their risk for malnutrition. We wished to determine whether there was any association between losses and dietary protein intake (DPI). METHODS:DPI was assessed from 24-h dietary recall using Nutrics software. Total protein losses were measured in 24-h collections of spent dialysate and urine. RESULTS:We studied, 41 patients, mean age 62.2 ± 15.8 years, 56.1% male, treated for 14.0 (3-23) months. Only13 (31.7%) met the recommended DPI target of ≥ 1.0 g/kg/day, and they had greater peritoneal protein losses 5.2 ± 2.4 versus 3.3 ± 1.1 g/day, p < 0.001, and faster peritoneal solute transfer rates (PTSR ×100 for protein 0.93 (0.58-1.21) versus 0.44 (0.35-0.56), p < 0.001). On multivariate analysis DPI was associated with calorie intake (standardized beta coefficient (Stꞵ) 0.56, p < 0.001, and peritoneal protein clearance rate (Stꞵ 0.36, p = 0.002). CONCLUSION:Patients with faster protein clearance and protein losses had higher DPI.
INTRODUCTION:This study aimed to assess the short-term antioxidant effects of a vitamin E-coated membrane during continuous kidney replacement therapy (CKRT) based on the neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW). METHODS:CKRT sessions conducted between December 2023 and May 2025 at a single tertiary-care center were retrospectively analyzed. Based on the type of hemofilter used, sessions were categorized into polysulfone membrane (PS) and vitamin E-coated membrane (VE) groups. Laboratory parameters at CKRT initiation and 48 h thereafter were compared between the two groups. RESULTS:Overall, 79 CKRT sessions (33 patients) were analyzed. In the PS group, NLR and RDW-SD increased significantly (p < 0.01 and p = 0.03), whereas no significant changes were observed in the VE group. CONCLUSION:Vitamin E-coated membranes may exert short-term antioxidant effects during CKRT by reducing inflammatory and oxidative responses as reflected by NLR and RDW.
BACKGROUND:Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing autoimmune disease of the central nervous system. High-dose intravenous methylprednisolone (IVMP) is the standard first-line therapy for acute attacks, although some patients remain refractory. Therapeutic apheresis is often used in such cases, although its efficacy in milder presentations or spinal cord-dominant forms remains less established. Few studies have quantitatively assessed the treatment effects using imaging, particularly magnetic resonance imaging (MRI)-based lesion measurements, leaving a gap in the objective evaluation of therapeutic outcomes. OBJECTIVE:We aimed to evaluate the clinical and radiological outcomes of therapeutic apheresis in patients with NMOSD, including those with mild disabilities, following IVMP. METHODS:We retrospectively analyzed eight patients with NMOSD treated between 2016 and 2023, who underwent therapeutic apheresis after IVMP for acute relapse. The Expanded Disability Status Scale (EDSS) scores and spinal cord lesion areas on T2-weighted MRI were compared before and after apheresis. RESULTS:Seven of eight patients showed clinical improvement, with EDSS scores improving from 5.5 ± 1.6 to 4.0 ± 2.3 (p = 0.007). Spinal cord lesion areas decreased from 4.21 ± 3.37 to 1.12 ± 0.657 cm2 (p = 0.03). Apheresis was effective even in patients with lower baseline EDSS scores. Seven of the eight patients had nonoptic neuritis, supporting efficacy for spinal cord-dominant NMOSD. CONCLUSIONS:Therapeutic apheresis following IVMP may benefit a broad range of patients with NMOSD, including those with mild symptoms and nonoptic presentations. Our findings underscore the importance of incorporating objective radiological assessments into future evaluations of treatment responses.
