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 (Ther Apher Dial )

Publisher: International Society for Apheresis; Nihon Afereshisu Gakkai; Nihon Tōseki Igakkai, Blackwell Publishing

Description

The value of apheresis treatment has been recognized in many fields of medicine. For this treatment to continue developing, it is imperative that doctors expand their knowledge of medicine, biology, biophysics, and engineering to refine their tools and techniques. Published quarterly, Therapeutic Apheresis and Dialysis is the primary source for the most up-to-date apheresis technologies and their clinical applications.

  • Impact factor
    1.53
  • 5-year impact
    1.26
  • Cited half-life
    5.20
  • Immediacy index
    0.27
  • Eigenfactor
    0.00
  • Article influence
    0.34
  • Website
    Therapeutic Apheresis and Dialysis website
  • Other titles
    Therapeutic apheresis and dialysis (Online), Ther Apher Dial
  • ISSN
    1744-9987
  • OCLC
    52766989
  • Material type
    Document, Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Blackwell Publishing

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    • On author or institutional or subject-based server
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    • Articles in some journals can be made Open Access on payment of additional charge
    • 'Blackwell Publishing' is an imprint of 'Wiley-Blackwell'
  • Classification
    ​ yellow

Publications in this journal

  • 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 10/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2009, we reported a “100-category checklist” for hemodialysis (HD) patients based on the International Classification of Functioning, Disability and Health. The purpose of the present study is to evaluate the validity and reliability of this checklist. The present study included 100 participants who had been on HD for at least 5 years when they were interviewed using the checklist. Subjects were asked whether they had experienced problems in each category since starting HD treatment. Categories for which more than 25% of subjects answered “yes” were extracted as problem categories. Additionally, the Kidney Disease Quality of Life (KDQOL) instrument was administered to the study subjects. Content validity was evaluated using the frequency and percentage of subjects who had a problem in each category. Criterion validity was performed based on correlation of the findings from the “100-category checklist” categories with the findings of the KDQOL. Construct validity was assessed based on the number of problem categories extracted as external criteria in carpal tunnel syndrome (CTS), anemia, and secondary hyperparathyroidism (SHPT). For reliability evaluation, we used Cronbach's coefficient alpha. Content validity showed that 54 were identified as problem categories. Criterion validity showed that 45 categories in all components correlated significantly with each subscale of the KDQOL. Construct validity showed that CTS, anemia, and SHPT contributed to an increased number of problems associated with HD. Cronbach's coefficient alpha of the “100-category checklist” was 0.86. This study confirmed the validity and reliability of the “100-category checklist”.
    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 10/2014;
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    ABSTRACT: Fibroblast growth factor (FGF) 23 plays an important role in regulation of renal phosphate excretion in patients with chronic kidney disease. However, it remains undetermined whether FGF23 is closely linked to renal phosphate handling in patients with low glomerular filtration rate (GFR). The present cross-sectional study included 52 outpatients undergoing peritoneal dialysis with urine volume ≥ 100 mL/day. The primary outcome was level of urinary phosphate excretion, and the secondary outcomes were tubular maximal reabsorption of phosphate normalized to GFR (TmP/GFR), an index of the renal threshold for phosphate excretion, and level of peritoneal phosphate excretion. Variates of interest were serum FGF23 and parathyroid hormone (PTH) levels. The median and interquartile range of serum FGF23 level, TmP/GFR, and total urinary and peritoneal phosphate excretion were 5610 (1493–11 430) ng/mL, 1.30 (0.44–1.86) mg/dL, 117 (40–234) mg/day, and 208 (156–250) mg/day, respectively. Multivariate linear regression analysis revealed that serum FGF23 level was significantly (P < 0.05) associated with TmP/GFR negatively and significantly (P < 0.05) associated with urinary phosphate excretion positively, even after adjusting for confounders. In contrast, none of the three outcome variates was associated with serum PTH level. Neither serum FGF23 nor PTH level was associated with peritoneal phosphate excretion. The present study indicates that FGF23, but not PTH, is involved in urinary phosphate regulation, even in patients on peritoneal dialysis with residual renal function.
    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 09/2014;
  • 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 09/2014;
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    ABSTRACT: Despite abnormal clotting, circuits clot during continuous renal replacement therapy (CRRT) in children with acute liver failure (ALF). We report our experience. All children with ALF needing CRRT were studied over 2 years. Patient and circuit factors associated with circuit use were evaluated. Thirty-one children in liver failure (median age 7.4 years) underwent CRRT, of which 17 (54.8%) died. A total of 98 filtration episodes were used. The smallest access catheter was 6.5 Fr, while the largest was 13.5 Fr. The most common filter used was HFO7 (63%). Mean duration (SD) of circuit use was 33.13(30.83) hours. Of the 98 filtration episodes, circuits blocked in 25, whereas the access catheter blocked in 25. Fifty-two circuits were changed electively for a variety of reasons. Prostacyclin was the anticoagulant in 62 filtration episodes. The remaining filtration episodes had either no anticoagulation or heparin. The mean (SD) “downtime” was 5.13 (9.15) hours. We found a significant association between fresh frozen plasma (FFP) use with circuit blockade. Neither the duration of CRRT nor the “downtime” influenced mortality. The CRRT circuits blocked in children despite deranged clotting in liver disease. Circuits are changed for a variety of reasons other than clotting. The use of FFP reduces circuit life.
    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 09/2014;
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    ABSTRACT: This study is aimed at exploring the role of serum fibroblast growth factor-23 (FGF-23), matrix Gla (MGP) and Fetuin-A in the calcium-phosphate metabolism and estimate the value of serum FGF-23, MGP and Fetuin-A levels in predicting osteoporosis in maintenance hemodialysis (MHD) patients. This study included 64 patients who receive hemodialysis in our hospital. The serum FGF-23, MGP and Fetuin-A were analyzed by enzyme-linked immunosorbent assay (ELlSA). Bone mineral density (BMD) at the femoral neck was measured by dual-energy X-ray absorptiometry. The 64 patients (30 males, 34 females, 60.6 ± 11.3 years of age) received an average of 6.88 ± 2.94 years of dialysis. Body mass index (BMI), Kt/V, dialysis vintage, patient age, serum levels of FGF-23, Fetuin-A, bone isoenzyme of alkaline phosphatase (ALP-B), and calcium were different in statistical significance among the three groups of patients in terms of normal bone mass (N = 10), osteopenia (N = 24), or osteoporosis (N = 30). BMI, Kt/V, ALP-B, dialysis vintage and serum Fetuin-A level were identified as independent variables of femoral neck BMD by stepwise multiple regression analysis. The area under ROC curve showed that serum Fetuin-A was useful for identifying osteoporosis in MHD patients. The cutoff value corresponding to the highest Youden's index was serum Fetuin-A ≤89 μg/mL, which was defined as the optimal predictor of osteoporosis. Its sensitivity/specificity was 71%/77.8%. The incidence of osteoporosis is high in MHD patients. Serum Fetuin-A level is closely correlated with osteoporosis and it may serve as a predictor of osteoporosis.
    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 09/2014;
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    ABSTRACT: Mesothelial cells are an integral part of the peritoneum and play an important role in maintaining its structural and functional properties. In recent years a number of studies on mesothelial cells have been performed to evaluate the localization, secretional properties and the ability of regeneration and transdifferentiation of these cells. They are also involved in the repair of the peritoneum damage following surgery or peritonitis. Mesothelial cells produce several cytokines, growth factors and extracellular matrix components, possessing anti-inflammatory and immunomodulatory properties. Based on previous research, cell sheet engineering has made it possible to transplant cells that retain the cells' function, and stacking different cells in layers has also become possible. Arranging blood vessels between the cell layers is a problem when stacking cells in layers. Whether adequate blood flow can be obtained for the cell layers to survive long-term is the difference between success and failure. Mesothelial cell transplantation for peritoneal regeneration needs to be performed under conditions in which the surface area of the visceral peritoneum is large and the mesothelial cell damage area is small. In this article we explain cell sheet engineering as one of the technologies for transplanting cells with a variety of intercellular adhesion and cell membrane molecules maintained intact, and its application to peritoneal regeneration.
    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 09/2014;
  • 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 09/2014;
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    ABSTRACT: Management of volume status is difficult in critically ill patients with renal failure. Volumetric hemodynamic indices are increasingly being used to guide fluid therapy in the intensive care unit (ICU), but are not established to monitor hemodialysis-induced fluid removal in critically ill patients. Using volumetric hemodynamic monitoring, changes in extravascular lung water index (EVLWI) and intrathoracic blood volume index (ITBVI) were measured immediately before and after hemodialysis sessions in 35 ICU patients. Additional hemodynamic and oxygenation related parameters were recorded at the same time, and online relative blood volume (RBV) monitoring was performed during hemodialysis. EVLWI decreased significantly with fluid removal (median 10.0 vs. 9.6 mL/kg, P = 0.001), whereas ITBVI remained stable (median 1012 vs. 1029 mL/m2, P = 0.402). Significant changes were also observed in stroke volume variation (median 12.0 vs. 13.0 %, P = 0.012), cardiac index (median 4.2 vs. 3.5 mL/min/m2, P = 0.003), mean arterial pressure (median 77 vs. 85.5 mmHg, P = 0.006), norepinephrine dose (median 0.092 vs. 0.114 μg/kg per min, P = 0.043), and hemoglobin values (median 9.5 vs. 10.4 gm/dL, P = 0.036). RBV decreased by 7.8% (median); there was no correlation with either the volumetric measurements or the other hemodynamic parameters recorded. EVLWI reduction with dialysis reflects the removal of excess body fluid, whereas preservation of cardiac preload is indicated by ITBVI stability. Volumetric hemodynamic measurements provide additional information concerning fluid status and are thus potentially useful to guide fluid removal on hemodialysis in critically ill patients.
    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 09/2014;
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    ABSTRACT: Many studies have reported poor vital prognosis in hepatitis C virus (HCV)-infected dialysis patients. The rate of HCV-infected dialysis patients in Japan is as high as 9.8%, and antiviral therapy is believed to be important for improving vital prognosis. We conducted a multicenter study to examine the administration method for pegylated interferon α-2a (PEG-IFNα-2a) monotherapy in HCV-infected dialysis. We studied 56 patients: 14 with low viral loads (HCV RNA < 5.0 log IU/mL) were treated with 90 μg PEG-IFNα-2a weekly, 42 with high viral loads (HCV RNA ≥ 5.0 log IU/mL) were treated with 135 μg PEG-IFNα-2a weekly. We examined the sustained virological response (SVR), factors affecting the SVR, and treatment safety. The overall SVR rate was 39% (22/56); that for genotype 1, genotype 2, low viral loads, and high viral loads was 29%, 67%, 93%, and 21%, respectively. From receiver operating characteristic (ROC) analysis, the HCV RNA cutoff values likely to achieve SVR for genotypes 1 and 2 were <5.7 log IU/mL (SVR rate: 64% 9/14) and <6.5 log IU/mL (SVR rate: 88% 7/8), respectively. If there was HCV RNA negativation at 4 weeks (rapid virological response), the SVR rate was 94% (16/17), whereas it was 6% (1/16) if there was HCV RNA positivity at 24 weeks. The rate of treatment discontinuation from adverse events or aggravated complications was 25% (14/56). High SVR rates can potentially be achieved with PEG-IFN monotherapy by identifying the target patients, based on virus type and viral load before initiating treatment and by modifying therapy during treatment according to responsiveness.
    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 09/2014;
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    ABSTRACT: The aim of the present study was to investigate the adverse outcomes of non-tunneled hemodialysis catheters and determinants in chronic hemodialysis patients receiving care at the Yaoundé General Hospital hemodialysis center, Cameroon. This was a prospective study of 11 months duration (February–December 2008) involving 81 non-tunneled non-cuffed catheters (63 femoral, 18 internal jugular) placed in 72 adults (47 men, 65.3%) on chronic hemodialysis. Baseline clinical and laboratory parameters associated with catheter-related complications during follow-up were investigated. The difference between variables was assessed using the χ2 test and equivalents. Sixty-five (80.2%) catheters were inserted for emergency dialysis, 11 (13.6%) for a failed native arteriovenous fistula and five (6.2%) for a failed prior catheter. The mean time-to-catheter removal was 35 ± 28 days. Catheter-related complications accounted for a third of catheter removals. The main catheter-related complications were infections (17/27, 62.9%) and bleeding (6/27, 22.2%), which were associated with unemployment (P = 0.0002) and longer duration of catheter (P = 0.004). The catheter-related infections were sepsis (11.8%), exit-site (29.4%) and both (58.8%); leading to death in 11/17 (64.7%) cases. Fever (94.1%), pain (88.2%) and pus (70.6%) were the main infectious signs with Staphylococcus aureus involved in 70.6%. Unemployment was significantly frequent in patients with infectious complications (76.5% vs. 26.6%, P = 0.0004). Non-tunneled hemodialysis catheters are mainly used for emergency dialysis through the femoral vein in this setting. Catheter-related infections due to Staphylococci are the leading complications associated with unemployment and longer utilization. Efforts are needed to improve early transfer of patients to nephrologists for better preparation for renal replacement therapy.
    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 09/2014;
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    ABSTRACT: The incidence of hypokalemia in continuous ambulatory peritoneal dialysis (CAPD) patients is about 15–60%, leading to significant complications. There is no standard treatment other than potassium supplement in this setting. The aim of this study was to evaluate effect of spironolactone 25 mg/day in CAPD patients who have a history of hypokalemia. This is a randomized, double-blind, placebo-controlled, cross-over study in CAPD patients who had a history of hypokalemia. Study intervention is 4 weeks of oral spironolactone 25 mg/day or placebo, cross-over after a 2-week wash-out period. The primary outcome was the difference of serum potassium before and after 4 weeks of spironolactone treatment. Serum potassium was measured every 2 weeks, serum magnesium, urine and peritoneal fluid potassium measured before and after each treatment period. We enrolled 24 patients, and 20 completed the cross-over study. Ten patients were anuric. The total doses of potassium supplement were the same during the study period. Serum potassium levels before and after study intervention were not significantly different in both groups (4.23 ± 0.64 vs. 3.90 ± 0.59 mEq/L for spironolactone P = 0.077 and 3.84 ± 0.62 vs. 3.91 ± 0.52 for placebo P = 0.551). Total 24-h potassium, magnesium, sodium excretion, urine volume and ultrafiltration volume were not affected by spironolactone or placebo. There was one episode of hyperkalemia (5.6 mEq/L) during the spironolactone treatment period. Spironolactone 25 mg/day does not have a significant effect on serum potassium or urine and peritoneal excretion rate in CAPD patients who have a history of hypokalemia.
    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 09/2014;
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    ABSTRACT: Kidney injury with concomitant hemodialysis is a common finding in perioperative care of liver transplant patients. The aim of this study was to evaluate disturbances in acid-base status, electrolyte balance and citrate accumulation during hemodialysis with regional citrate anticoagulation in perioperative care of liver transplant recipients. A retrospective, single center evaluation was conducted of patients with severe liver dysfunction receiving renal replacement therapy in the perioperative care of liver transplantation in a multidisciplinary ICU of a university hospital. Within 5 days of ICU stay, 89 patients undergoing liver transplantation received regional citrate anticoagulation for hemodialysis. During the study period pH (7.39 [7.33/7.43] vs. 7.44 [7.39/7.47], P-value = 0.014), base excess values (−0.9 [−5.08/2.35] vs. 4.3 [1.93/8.21], P-value = 0.001) and standard bicarbonate (23.6 [20/26.9] vs. 28.2 [26.2/32.2], P-value = 0.001) significantly increased, whereas lactate levels (2.6 [1.60/4.45] vs. 1.25 [0.98/1.9], P-value = 0.071) and Catot/Caion-ratio decreased or remained below the upper reference. Hypocalcemia appeared mostly within 48 h after dialysis initiation. Although sodium levels increased during the observation, rates of hypernatremia were comparable between hemodialysis days 1 and 5. Hemodialysis using regional citrate anticoagulation remains a challenge in the perioperative care of liver transplant recipients. Major attention must be paid to acid-base disturbances and citrate accumulation within 48 h after dialysis initiation. Nevertheless, regional citrate anticoagulation in liver dysfunction is a feasible and valuable tool, when limitations and pitfalls are adequately considered.
    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 09/2014;
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    ABSTRACT: Cerebrovascular diseases, including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, remain prevalent causes of morbidity and mortality among dialysis patients. Their mortality rate for cerebrovascular diseases is roughly three times higher than that in the general population. However, whether mortality rates for all subtypes of cerebrovascular diseases are equally higher has not been evaluated. The aim of this study was to determine the mortality rate for each stroke subtype, comparing dialysis patients and the general population in Japan. We used mortality data reported by the Japanese Society for Dialysis Therapy and national Vital Statistics data between 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for stroke subtypes including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage. During the 2-year study period, 51 994 and 933 deaths from intracerebral hemorrhage, 79 124 and 511 deaths from cerebral infarction, and 24 957 and 147 deaths from subarachnoid hemorrhage were recorded per 252 million person-years and per 546 474 dialysis patient-years, respectively. Standardized mortality ratios among dialysis patients relative to the general population were 3.8 (95% confidence interval, 3.6–4.1), 1.3 (1.2–1.4), and 1.3 (1.1–1.6) for intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, respectively. Intracerebral hemorrhage was the highest cause of mortality in the dialysis population, although cerebral infarction was the highest in the general population. Relative to the general population in Japan, Japanese dialysis patients had higher mortality rates, especially for intracerebral hemorrhage.
    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 09/2014;
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    ABSTRACT: Metabolic syndrome confers an increased risk of cardiovascular disease (CVD) in the general population. The relationship between adiponectins, and clinical outcomes in patients undergoing hemodialysis remains controversial. We investigated whether adiponectins, biomarkers of inflammation, nutrition status and clinical features predict the mortality of patients undergoing hemodialysis for 6 years. We measured baseline plasma total and high-molecular-weight (HMW) adiponectins, tumor necrosis factor (TNF)-α, serum high sensitivity C-reactive protein (hsCRP), and clinical characteristics including visceral fat area (VFA) and the Geriatric Nutritional Risk Index (GNRI) in 133 patients undergoing chronic hemodialysis. Forty-one of the 133 patients died during follow-up. The deceased patients were significantly older, had more prior CVD and diabetes, higher TNF-α and hsCRP levels but lower GNRI. VFA, and total and HMW adiponectin did not significantly differ between the two groups. TNF-α and hsCRP levels and GNRI score were significant for predicting all-cause and cardiovascular mortality in receiver operating curve analyses. When stratified by a GNRI score of 96, Cox proportional hazards analyses identified TNF-α as a significant predictor of all-cause mortality (hazard ratio [HR] 1.23; P = 0.038) and hsCRP as a significant predictor of all-cause and cardiovascular mortality (HR, 2.32, P = 0.003; HR 2.30, P = 0.012, respectively) after adjusting for age, sex, diabetes mellitus, and prior CVD, only in malnourished patients. These results demonstrate that malnutrition and the inflammatory markers TNF-α and hsCRP, but not metabolic markers, including VFA and adiponectins have a significant impact on 6-year all-cause and cardiovascular mortality in Japanese patients undergoing hemodialysis.
    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 09/2014;
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    ABSTRACT: Reduction of platelets is a common finding in patients with liver disease and can be aggravated by extracorporeal therapies, e.g. artificial liver support. The impact of extracorporeal albumin dialysis on the time count and time course of platelets in liver failure patients was evaluated in a randomized controlled clinical trial. Mean thrombocyte reduction during a single extracorporeal liver support therapy was −15.1% [95%CI: −17.7; −12.5]. No differences were found between treatments of patients with a more reduced platelet count (<100 GPT/L: −15.6% [−19.5; −11.7%]; n = 43) compared to patients with normal or slightly decreased thrombocytes (−14.6% [−18.3%; −11.0%]; n = 43; P = 0.719). The variation of platelet count within 24 h after onset of extracorporeal therapy treatment was less, albeit significant (−3.5% [−6.3%; −0.7%], P < 0.016). Absolute thrombocyte variability was comparable between both groups (with extracorporeal therapy −5.6 GPT/L [−9.7; −1.4], without extracorporeal therapy −1.3 GPT/L [−7.3; 4.7]; P = 0.243), whereas relative decrease of thrombocytes within a 24-h period of extracorporeal therapy was greater than the changes in patients without extracorporeal therapy (−3.5% [−6.3%; −0.7%] vs. 2.0% [−2.0%; 5.9%]; P = 0.026]. Within a period of two weeks after enrollment, no significant differences of platelet count were observed either between the two groups or in the time course (Pgroup = 0.337, Ptime = 0.277). Reduction of platelets during intermittent extracorporeal liver support was less pronounced within a 24-h period as before and after a single treatment and was comparable to variations in the control group without extracorporeal therapy.
    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 09/2014;
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    ABSTRACT: Extracorporeal membrane oxygenation (ECMO) is used as a salvage therapy in refractory acute respiratory distress syndrome (ARDS). Although technological progress in the ECMO systems improved the survival rate, prognosis is still significantly worsened by acute kidney injury (AKI), particularly if renal replacement therapy (RRT) is required. There are no exact guidelines recommending which techniques of ECMO and continuous RRT (CRRT) should be used for management of AKI coexisting with respiratory or circulatory failure, and how to combine them. The aim of this review is to describe methods of CRRT and ECMO simultaneous application, and to present advantages of various technical approaches versus possible complications.
    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 09/2014;
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    ABSTRACT: Dementia is common in chronic hemodialysis (HD) patients and is associated with a higher mortality. Factors associated with dementia in HD patients are not clear. We investigated factors associated with early dementia in HD patients. Chronic HD patients of 27 hemodialysis centers were enrolled in 2013. Early dementia was identified using the AD8 assessment. Factors associated with early dementia were analyzed using logistic regression. A total of 1617 chronic HD patients including 820 males and 797 females, aged 63.3 ± 13 years, dialyzed for 4 (1.8–8.4) years were analyzed. Early dementia was identified in 414 (25.6%) of the patients. Longer HD times were associated with a lower chance of dementia (P = 0.032), with an adjusted odds ratio (OR) of 0.522 (95% confidence interval [CI]: 0.270–0.969) for every one more hour of HD. Patient's age (OR: 1.587, 95% CI: 1.406–1.791, P < 0.001), body mass index (OR: 0.958, 95% CI: 0.921–0.996, P = 0.031), cerebrovascular accident (OR: 1.480, 95% CI: 1.000–2.188), diabetes (OR: 1.894, 95% CI: 1.390–2.581, P < 0.001), and serum albumin (OR: 0.376, 95 % CI: 0.256–0.553, P < 0.001) were independently linked to early dementia. Short hemodialysis times are associated with early dementia in a chronic hemodialysis population with a quarter of patients having early dementia. Patients' age, nutrition status and comorbidity are independently linked to early dementia.
    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 09/2014;
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    ABSTRACT: Asymmetric dimethylarginine (ADMA) as a uremia toxin is accumulated in end-stage renal disease (ESRD) patients. Elevated ADMA level has been shown to be predictive of cardiovascular diseases (CVDs) and all-cause mortality in ESRD. Therefore, we investigated the effect of prolonged hemodialysis (HD) treatment on the levels of serum ADMA, arginine, nitric oxide (NO), soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1). Seventy-five patients (M/F = 40/35) with chronic renal failure (CRF) and who were on HD were divided into five groups with differing treatment periods of HD; from 6 to 24 months to 97–120 months. Fifteen apparently healthy subjects acted as controls. The serum levels of ADMA, sICAM-1 and sVCAM-1 were increased in all patient groups compared to the control group. No significant difference was observed when the patient groups were compared in terms of HD treatment periods. Nitric oxide levels were lower in the three groups who were treated for periods of 49–72, 73–96, 97–120 months compared to the control group. The L-arginine to ADMA ratio was decreased in all patient groups compared to controls. Consequently, our investigations have shown that in HD continued for more than 4 years NO levels began to decrease significantly and the levels of serum ADMA, sICAM-1 and sVCAM-1 levels increased although this increase was not affected by the period in which hemodialysis treatment was applied.
    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 08/2014; 18(4).

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