Blood Purification最新文献

{"title":"Endotoxin removal in cardiac bypass surgery in 2026: where do we stand, and where are we going?","authors":"Thibault Gennart, Anne-Sophie Dincq, Sebastien Redant, Willem Boer, Patrick M Honoré","doi":"10.1159/bpu/abpag027","DOIUrl":"https://doi.org/10.1159/bpu/abpag027","url":null,"abstract":"<p><p>The significance of endotoxemia during cardiopulmonary bypass remains incompletely understood. This review summarizes decades of research and highlights that clinically relevant endotoxemia affects only a subset of patients, making indiscriminate endotoxin-targeted therapies unlikely to provide meaningful benefit. Future research should therefore focus on identifying high-risk phenotypes, refining endotoxin assessment, and developing personalized therapeutics. Key priorities include standardization of endotoxin measurement, source tracking, gut barrier dysfunction, bypass-related factors, immunological profiling, EndoCAb-guided risk stratification, novel pharmacological approaches, and extracorporeal endotoxin removal. Regarding patient selection for therapeutic intervention, two high-risk subgroups warrant consideration. First, patients with EAA values >0.40 may be considered biologically exposed, while those with EAA values >0.60 represent a subgroup with endotoxin activity approaching levels seen in severe systemic inflammation or sepsis. Importantly, endotoxin activity must always be interpreted in relation to the host's neutralizing capacity. Second, reduced EndoCAb levels independently predict adverse outcomes after cardiac surgery, including prolonged mechanical ventilation, postoperative complications, and extended hospitalization. These patients may be particularly vulnerable to even moderate endotoxin exposure due to impaired endogenous neutralization. Precision medicine strategies targeting these identifiable subgroups represent the most promising path forward.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney volumetry for predicting long-term outcome in acute kidney injury: A retrospective cohort study.","authors":"Shunsuke Tagami, Ryota Inokuchi, Akinori Maeda, Yohei Komaru, Tomoki Wada, Teruhiko Yoshida, Yoshihisa Miyamoto, Kent Doi","doi":"10.1159/bpu/abpag020","DOIUrl":"https://doi.org/10.1159/bpu/abpag020","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous renal replacement therapy (CRRT) is effective for severe acute kidney injury (AKI); however, predicting successful CRRT discontinuation and long-term outcomes remains challenging. Although urinary neutrophil gelatinase-associated lipocalin (NGAL) levels and kidney volume measured by computed tomography (CT) have been associated with renal prognosis, it remains unclear whether their combination improves predictive accuracy. This study evaluated whether combining urinary NGAL levels with kidney volume measured by CT improves prediction accuracy.</p><p><strong>Methods: </strong>In this retrospective cohort study, urinary NGAL levels and height-adjusted total kidney volume (HtTKV) were assessed for their ability to predict successful CRRT discontinuation and major adverse kidney events at 90 days (MAKE90).</p><p><strong>Results: </strong>Among the 74 patients included, CRRT discontinuation was successful in 55 (74.3%), and MAKE90 occurred in 31 (41.9%). Urinary NGAL (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.76-0.95) was a significant predictor of CRRT discontinuation, whereas HtTKV was not. For long-term outcomes, urinary NGAL (AUC, 0.73 [95% CI, 0.61-0.85]) and HtTKV (AUC, 0.67 [95% CI, 0.54-0.80]) were significantly associated with MAKE90. Adding HtTKV to urinary NGAL significantly improved prediction of MAKE90, as demonstrated by reclassification analyses (net reclassification improvement and integrated discrimination improvement).</p><p><strong>Conclusions: </strong>Adding HtTKV significantly improved the prediction of long-term MAKE90 based on NGAL levels, but not that of short-term CRRT discontinuation. These findings in this proof-of-concept study suggest that structural kidney assessment by CT volumetry may complement urinary NGAL for long-term risk stratification in patients with severe AKI requiring CRRT.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Italian Cooperative HemoAdsorption Study for Relief of Uremic Symptoms (ICHARUS): Study Protocol for a Prospective, Multicenter, Real-World Registry.","authors":"Matteo Floris, Matteo Marcello, Guido Gembillo, Marco Fiorentino, Fulvia Zappulo, Sara Samoni, Thiago Reis, Gonzalo Ramírez-Guerrero, Vincenzo Cantaluppi, Alessandra Brendolan, Domenico Santoro, Loreto Gesualdo, Gaetano La Manna, Giuseppe Castellano, Natascha Perin, Sara Maria Pani, Antonello Pani, Claudio Ronco","doi":"10.1159/bpu/abpag026","DOIUrl":"https://doi.org/10.1159/bpu/abpag026","url":null,"abstract":"<p><p>Persistent uremic symptoms remain common among patients receiving maintenance hemodialysis, even when contemporary dialysis prescriptions are optimized. These symptoms are only partially captured by conventional adequacy metrics and represent a major determinant of health-related quality of life. A growing body of evidence suggests that incomplete removal of protein-bound uremic toxins and larger middle molecules contributes to persistent symptom burden. Hemoadsorption, when integrated into the extracorporeal circuit, provides an additional clearance mechanism that may enhance solute removal beyond diffusion and convection alone. The ICHARUS study is a prospective, multicenter, observational, real-world registry enrolling adult patients receiving hemodialysis with persistent uremic symptoms despite optimized conventional therapy. Hemoadsorption combined with hemodialysis will be prescribed according to routine clinical practice. Study visits are scheduled at baseline and at one, three, and six months. The primary endpoint is the change in patient-reported symptom burden, assessed using the Dialysis Symptom Index, from baseline to three months. Secondary endpoints include changes in symptom-specific patient-reported outcomes, health-related quality of life, selected biochemical markers, and safety. By focusing on patient-reported outcomes in a pragmatic setting, the ICHARUS study aims to generate structured real-world evidence on the feasibility, safety, and potential clinical relevance of hemoadsorption combined with hemodialysis, supporting patient phenotyping and informing future hypothesis-driven interventional studies. ClinicalTrial.gov ID: NCT07522008.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best Practices in Performing CRRT during ECMO: Workgroup Statements from the Joint Acute Disease Quality Initiative (ADQI) and Extracorporeal Life Support Organization (ELSO) Consensus Conference on ECMO, AKI, Fluid Management and CRRT.","authors":"Sean M Bagshaw, Marta Velia Antonini, Alex Lepage-Farrell, David Michael McMullan, Theresa Mottes, Katja M Gist, David T Selewski, Claudio Ronco, Kianoush Kashani, Graeme MacLaren","doi":"10.1159/bpu/abpag023","DOIUrl":"https://doi.org/10.1159/bpu/abpag023","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is a well-established life support technology. However, among patients receiving ECMO, acute kidney injury (AKI) is common, and a substantial proportion receive concomitant support with renal replacement therapy (RRT). There are several techniques for combining RRT with ECMO in patients, including the use of in-line hemofilters in the ECMO circuit, integrated RRT machine circuits into the ECMO circuit and the use of parallel circuits where ECMO and CRRT are provided by discrete vascular access. Enclosed is a summary of work group findings from the joint Acute Disease Quality Initiative (ADQI) and Extracorporeal Life Support (ELSO) consensus meeting focused on \"ECMO, AKI, Fluid Management and CRRT,\" which identified priorities, knowledge gaps and research opportunities, along with generating key consensus-based statements to guide best practices for performing CRRT during ECMO.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing Protocols and Observed Outcomes of TR-350 Immunoadsorption in Neuromyelitis Optica Spectrum Disorder: A Single-Center Experience of 334 Procedures.","authors":"Limin Wang, Akehu Alemasi, Jing Liu, Yong Gong, Yin Zhang, Yunjin Xiong","doi":"10.1159/bpu/abpag021","DOIUrl":"https://doi.org/10.1159/bpu/abpag021","url":null,"abstract":"<p><strong>Introduction: </strong>We describe an institutional nursing protocol used for patients with neuromyelitis optica spectrum disorder (NMOSD) undergoing TR-350 tryptophan immunoadsorption (IA) therapy. We retrospectively analyzed the clinical and nursing records of 67 patients with NMOSD who underwent TR-350 IA between January 2019 and August 2025.</p><p><strong>Methods: </strong>We evaluated 334 treatment sessions and recorded demographic characteristics, observed clinical and serological changes, adverse events, and device alarms. Nursing management before, during, and after the procedure was reviewed.</p><p><strong>Results: </strong>After the IA treatment course, reductions in the median Expanded Disability Status Scale score and the geometric mean anti-aquaporin-4 immunoglobulin G (AQP4-IgG) titer, together with improvement in visual acuity, were observed. Laboratory testing revealed hypofibrinogenemia (<1.0 g/L) in 13 of 67 patients (19.4%). Nurses identified hypotension in two sessions (2/334, 0.6%) and catheter-site bleeding in one session (1/334, 0.3%); in all, 29 device-alarm events were recorded. With nursing intervention and timely troubleshooting, 333 of 334 sessions were completed; one session (0.3%) was terminated prematurely because of extracorporeal circuit clotting.</p><p><strong>Conclusion: </strong>TR-350 IA demonstrated feasibility and safety in this cohort of patients with steroid-refractory NMOSD. Adherence to nursing protocols refined locally from institutional standard operating procedures and clinical experience, together with proactive management of complications, supported a high treatment completion rate and patient safety.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Protein Intake with Protein-Energy Wasting in Patients Undergoing Post-Dilution Online Hemodiafiltration.","authors":"Gabriela Leal-Escobar, Salvador López-Gil, Annabel Biruete, Magdalena Madero, Ivan Armando Osuna-Padilla","doi":"10.1159/bpu/abpag018","DOIUrl":"10.1159/bpu/abpag018","url":null,"abstract":"<p><strong>Introduction: </strong>Protein-energy wasting (PEW) is a frequent complication in patients receiving kidney replacement therapy and is associated with adverse clinical outcomes. Hemodiafiltration (HDF), a convective dialysis modality, enhances uremic toxin removal but may also increase nutrient losses, potentially contributing to nutritional impairment. This study evaluated the prevalence of PEW and its association with protein intake in patients undergoing post-dilution online HDF.</p><p><strong>Methods: </strong>This cross-sectional study included 98 adults receiving post-dilution online HDF at a tertiary care center between March 2024 and July 2025. Nutritional status was assessed using the Malnutrition Inflammation Score (MIS); PEW was defined as MIS ≥8. Body composition was evaluated by bioelectrical impedance analysis, and dietary intake was assessed using 3-day food records. Multivariable linear regression models were used to analyze the association between protein intake and MIS.</p><p><strong>Results: </strong>PEW was identified in 45% of patients. Compared with patients without PEW, those with PEW had lower body mass index, fat-free mass index, phase angle, handgrip strength, energy intake, and protein intake, as well as greater fluid overload. Patients with PEW also exhibited lower serum phosphorus and higher C-reactive protein concentrations. Individuals consuming <1.2 g/kg ideal body weight/day of protein had lower energy intake and tended to present higher MIS scores. In multivariable analysis, lower protein intake remained independently associated with poorer nutritional status, corresponding to an approximately 2-point higher MIS score.</p><p><strong>Conclusion: </strong>PEW is highly prevalent among patients undergoing post-dilution online HDF and is independently associated with lower protein intake. These findings support the need for individualized nutritional assessment and prospective studies evaluating optimal nutritional strategies in HDF populations.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of splenic volume and oxygenation during hemodialysis.","authors":"Yusaku Watanabe, Kiyonori Ito, Hiroaki Nonaka, Yuko Mutsuyoshi, Junki Morino, Haruhisa Miyazawa, Jo Yoshizawa, Sumiko Homma, Mamoru Yoshizawa, Yasushi Asano, Yoshiyuki Morishita, Susumu Ookawara","doi":"10.1159/bpu/abpag024","DOIUrl":"https://doi.org/10.1159/bpu/abpag024","url":null,"abstract":"<p><strong>Introduction: </strong>During hemodialysis (HD), the redistribution of blood from the hepatosplanchnic vascular bed to the central circulation is a key compensatory response to ultrafiltration. A major blood reservoir, the spleen can expel red blood cells into the circulation upon contraction. However, changes in splenic volume and oxygenation during HD have yet to be fully investigated.</p><p><strong>Methods: </strong>Splenic regional oxygen saturation (rSO₂) was measured in 48 patients (33 men, 15 women) during HD using an INVOS 5100C oxygen saturation monitor (Covidien Japan, Tokyo, Japan). We assessed the spleen index by ultrasonography before and after the same HD session.</p><p><strong>Results: </strong>The splenic rSO₂ of patients undergoing HD was significantly lower than that of healthy controls (64.3 ± 13.4 vs. 87.0 ± 5.1%, p < 0.001). In contrast, no significant difference was detected between the pre- and post-HD values (64.3 ± 13.4 vs. 64.5 ± 13.6%, p = 0.890). The spleen index did not differ significantly between healthy control and pre-HD (31.3 [24-33] vs. 32.6 [23-40] cm², p = 0.416). However, the spleen index decreased significantly after HD (32.6 [23-40] vs. 28.1 [20-35] cm², p = 0.009). Multivariate regression analysis also showed that the pre-HD spleen index (standardized coefficient = -0.319), serum creatinine concentration (standardized coefficient = -0.492), and serum β2-microglobulin level (standardized coefficient = 0.344) were independently associated with changes in the spleen index.</p><p><strong>Conclusion: </strong>In conclusion, splenic rSO₂ did not change significantly during HD, whereas the spleen index decreased. This reduction may reflect active splenic contraction, passive venous decongestion, or both.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison of phosphate-containing versus conventional hemodialysis solutions for citrate-anticoagulated continuous veno-venous hemodialysis in patients with acute kidney injury.","authors":"Alina Saira Ross, Thomas Dimski, Sebastian Roth, Erik Michael, Detlef Kindgen-Milles","doi":"10.1159/bpu/abpag025","DOIUrl":"https://doi.org/10.1159/bpu/abpag025","url":null,"abstract":"<p><p>Introduction Acute kidney injury (AKI) frequently necessitates continuous renal replacement therapy, often causing phosphate and magnesium losses. We evaluated whether a phosphate containing, magnesium-enriched dialysate reduces hypophosphatemia and hypomagnesemia compared to phosphate-free dialysate with standard magnesium concentration during citrate-anticoagulated continuous veno-venous hemodialysis (RCA-CVVHD) in ICU patients. Methods Single-center observational study comparing two adult ICU cohorts undergoing RCA-CVVHD from 2011-2014. The 2011-2012 cohort received phosphate-free dialysate with standard magnesium concentration (0.75 mmol/L) and intravenous phosphate and magnesium supplementation. The 2013-2014 cohort received a phosphate-containing (1.25 mmol/L), magnesium-enriched (1.0 mmol/L) dialysate. The primary endpoint was the incidence of hypophosphatemia and severe hypophosphatemia within 72 hours. Secondary outcomes included magnesium and calcium disturbances, delivered dialysis dose, solute control, filter lifespan, and clinical outcomes. Results We analyzed 85 patients in the 2011-2012 and 97 in the 2013-2014 cohort. Hypophosphatemia (92% vs. 68%, p < 0.001) and severe hypophosphatemia (65% vs. 28%, p < 0.001) were less frequent with phosphate-containing dialysate. Phosphate and magnesium levels were higher (p<0.008) with the phosphate-containing, magnesium-enriched solution. Fewer patients required phosphate (23% vs. 81%, p < 0.001) or magnesium (35% vs. 76%, p < 0.001) infusions. Ionized calcium and total calcium remained within target range in both cohorts. The delivered dialysis dose was 31.0±8.1 mL/kg/h in the 2011-2012 and 28.6±6.6 mL/kg/h in the 2013-2014 cohort (p = 0.025). More filters reached the maximum lifespan of 72 hours in the 2013-2014 cohort (64% vs. 75%; p = 0.03). Solute clearance and acid-base control were similar. Conclusion In ICU patients undergoing RCA-CVVHD, a phosphate-containing, magnesium-enriched dialysate was associated with significantly lower incidence and severity of hypophosphatemia, higher phosphate and magnesium levels, and lower need for separate electrolyte infusions. This phosphate-containing solution may offer relevant benefits, including reduced workload and potentially increased patient safety. These findings require confirmation in a RCT that includes relevant clinical endpoints.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accelerating implementation science in Acute Kidney Care: Let's roll up our sleeves!","authors":"Jeremiah Brown, Javier A Neyra, Ravindra L Mehta, Oleksa Rewa","doi":"10.1159/bpu/abpag022","DOIUrl":"https://doi.org/10.1159/bpu/abpag022","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Remote Patient Monitoring in Peritoneal Dialysis: A \"Less is More\" Approach to Clinical Decision Support.","authors":"Sabrina Milan Manani, Grazia Maria Virzì, Andrea Giuseppe Santoro, Matteo Marcello, Paolo Luca Lentini, Claudio Ronco, Monica Zanella","doi":"10.1159/bpu/abpag019","DOIUrl":"10.1159/bpu/abpag019","url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD) is a home-based renal replacement therapy designed to preserve patient autonomy and enhance quality of life. The advent of telemedicine and e-health technologies has enabled the widespread adoption of remote patient monitoring (RPM), particularly in automated PD (APD). This study aimed to evaluate the impact of optimizing RPM strategies in clinical practice.</p><p><strong>Methods: </strong>This retrospective observational study compared two cohorts of patients treated with APD supported by RPM during different time periods: 35 patients monitored daily in 2019 and 62 patients managed in 2024 according to a personalized clinical surveillance protocol based on clinical stability stratification.</p><p><strong>Results: </strong>The new protocol implemented intermittent monitoring of key treatment parameters - ultrafiltration volume, alarms, bypass events, cycle times, and missed sessions - supported by an automated alert system to prompt timely clinical intervention. Both cohorts were comparable in demographic and baseline clinical characteristics. No statistically significant differences were observed between groups in terms of adverse events (peritonitis, hospitalizations) or dialysis adequacy.</p><p><strong>Conclusion: </strong>We transitioned from a daily monitoring model to a selective, stratified approach, thereby establishing a personalized strategy tailored to the needs of individual patients. The success of this selective model can be attributed to a robust digital infrastructure, targeted education for patients and caregivers, and well-defined shared operating protocols between nurses and physicians. These findings support the effectiveness and sustainability of a \"less-is-more\" approach to RPM in APD patients, paving the way for future integration of predictive algorithms and artificial intelligence to enable more personalized and efficient clinical surveillance.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"1"},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}