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

{"title":"Limited Interchangeability of Shunt-Side SpO₂ Measurements During Hemodialysis.","authors":"Kazue Kojima, Yuichi Hirate, Yuika Wada, Takashi Nakajima, Koji Nakai","doi":"10.1002/1744-9987.70207","DOIUrl":"https://doi.org/10.1002/1744-9987.70207","url":null,"abstract":"<p><strong>Introduction: </strong>During hemodialysis, SpO₂ is measured on the non-shunt side, restricting movement. This single-center, prospective, observational study evaluated shunt-side interchangeability.</p><p><strong>Methods: </strong>Forty-five patients underwent double-sided finger-sensor SpO₂ monitoring at five time points. Between-site agreement was assessed using Lin's concordance correlation coefficient (CCC), Deming regression, Bland-Altman analysis, and accuracy root mean square (Arms). Confidence intervals were calculated using subject-level cluster bootstrap resampling (2000 iterations; seed = 42). Using vector-type visualization, relationships between paired measurements were illustrated.</p><p><strong>Results: </strong>SpO₂ showed similar distributions between sites. The Spearman correlation was ρ = 0.705. CCC was 0.720 (95% CI: 0.590-0.811). Deming regression yielded y = 0.989x + 1.087. Bland-Altman bias was 0.060% (limits of agreement, ±3%). Arms were 1.41%, and the visualization showed minimal angular deviation (median |θ-45°| = 0.29°).</p><p><strong>Conclusion: </strong>Shunt-side SpO₂ may be acceptable in selected clinical contexts, although interindividual variability warrants caution. These findings are not applicable to hypoxic states (SpO₂ < 90%).</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of Serum miR-3150b-3p for Vascular Calcification in Hemodialysis Patients.","authors":"Ping Xia, Yusen Cai, Li Liu, Yuezhen Zhang","doi":"10.1002/1744-9987.70190","DOIUrl":"https://doi.org/10.1002/1744-9987.70190","url":null,"abstract":"<p><strong>Background: </strong>Vascular calcification (VC) is prevalent among hemodialysis (HD) patients and represents a key factor contributing to high mortality rates. Therefore, there is a need for biomarkers capable of accurately and efficiently diagnosing VC.</p><p><strong>Aim: </strong>To investigate the predictive value of miR-3150b-3p for VC.</p><p><strong>Methods: </strong>Clinically, we recruited 145 HD patients with VC and 120 without VC. Serum levels of miR-3150b-3p were evaluated by RT-qPCR. The predictive value of miR-3150b-3p for VC was assessed using ROC curves and logistic regression models. PTH and osteocalcin levels were measured by ELISA. Target gene prediction was performed using bioinformatics methods.</p><p><strong>Results: </strong>Noncalcified and calcified HD patients showed significant differences in age, dialysis duration, ALP, calcium, and CRP. Furthermore, miR-3150b-3p was upregulated in the calcified group, with higher levels correlating to more severe calcification. Logistic regression analysis indicated that miR-3150b-3p, age, and CRP were independent risk factors for VC development, with miR-3150b-3p demonstrating good diagnostic performance for VC. Crucially, miR-3150b-3p positively correlated with PTH and osteocalcin levels. Bioinformatics analysis revealed that its target genes were extensively involved in processes such as transcriptional regulation, nervous system development, and cell differentiation. Furthermore, these target genes may participate in pathways including cancer, axon guidance, and thyroid hormone signaling.</p><p><strong>Conclusion: </strong>Overexpressed miR-3150b-3p participated in the VC process of HD patients. Furthermore, it exhibited potential predictive value for VC. Our study provides an alternative diagnostic biomarker for VC.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Plasma Exchange in the Pediatric Intensive Care Unit: Analysis of Clinical Outcomes.","authors":"Ibrahim Bingol, Merve Yavuz, Hacer Ucmak","doi":"10.1002/1744-9987.70149","DOIUrl":"10.1002/1744-9987.70149","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the indications, clinical outcomes, and predictors of mortality associated with therapeutic plasma exchange (TPE) in critically ill pediatric patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"551-559"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centrifugation Selective Plasma Exchange: A Novel Hybrid Modality Combining Centrifugal Separation and Membrane-Based Plasma Fractionation.","authors":"Takatoshi Sakurasawa, Atsushi Ohkubo, Soichiro Iimori, Shotaro Naito","doi":"10.1002/1744-9987.70163","DOIUrl":"10.1002/1744-9987.70163","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"452-459"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection Control Practices for Vascular Access Management in Hemodialysis: Results From a Nationwide Survey of Japanese National University Hospitals.","authors":"Aiko Yamada, Makoto Harada, Tadahiko Kikugawa, Takeshi Nakata, Koji Hashimoto, Tsuneo Konta, Yuji Kamijo","doi":"10.1002/1744-9987.70151","DOIUrl":"10.1002/1744-9987.70151","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>Two questionnaire surveys were conducted between 2019 and 2022, with responses obtained from all 42 hospitals.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Infection control practices during VA cannulation and connection varied even among national university hospitals. Further studies evaluating associations with infection outcomes are needed.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"594-601"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Apheresis for Intravenous Methylprednisolone-Refractory Neuromyelitis Optica Spectrum Disorder: Clinical and Radiological Outcomes in a Single-Center Case Series.","authors":"Wataru Horiguchi, Daisuke Katagiri, Takeyuki Watadani, Shunichi Matsuda, Hiroshi Kaneko, Noritoshi Arai","doi":"10.1002/1744-9987.70145","DOIUrl":"10.1002/1744-9987.70145","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>We aimed to evaluate the clinical and radiological outcomes of therapeutic apheresis in patients with NMOSD, including those with mild disabilities, following IVMP.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"536-543"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a Novel Low-Density Lipoprotein Apheresis Device Rheocarna in Patients Undergoing Hemodialysis With Chronic Limb-Threatening Ischemia: A Single-Center Retrospective Study.","authors":"Kunihiro Ishioka, Takayasu Ohtake, Kei Ohmori, Chika Shibuya, Tomoki Tsukahara, Mizuki Yamano, Yasuhiro Mochida, Machiko Oka, Kyoko Maesato, Yusuke Tsukamoto, Hidekazu Moriya, Sumi Hidaka, Shuzo Kobayashi","doi":"10.1002/1744-9987.70164","DOIUrl":"10.1002/1744-9987.70164","url":null,"abstract":"<p><strong>Background: </strong>Chronic limb-threatening ischemia (CLTI) is a severe form of lower-extremity artery disease characterized by distal lesions and microcirculatory impairment, limiting revascularization efficacy. Rheocarna is a direct hemoperfusion low-density lipoprotein (LDL) adsorption device with potential rheological and anti-inflammatory benefits. The real-world effectiveness of Rheocarna in patients with advanced CLTI undergoing hemodialysis (HD) remains unclear. This study evaluated clinical outcomes of Rheocarna therapy in patients with CLTI undergoing HD.</p><p><strong>Methods: </strong>We retrospectively reviewed 31 patients undergoing HD (mean [±SD] age 67 ± 11 years) with CLTI treated with Rheocarna at a single center. Primary outcomes were ulcer healing at 6 months and amputation-free survival (AFS) at 1 year, with baseline characteristics compared between healed and non-healed groups.</p><p><strong>Results: </strong>At 6 months, the ulcer healing, major amputation, and mortality rates were 25.8%, 35.5%, and 22.6%, respectively. The 1-year AFS rate was 40%. The mean ankle-brachial index significantly improved from 1.00 ± 0.17 to 1.07 ± 0.15 (p = 0.041).</p><p><strong>Conclusion: </strong>Rheocarna may support wound healing and limb salvage in patients with CLTI undergoing HD; however, its clinical effectiveness appears limited in advanced disease stages.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"476-481"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of Long-Term Continuous Renal Replacement Therapy and the Impact of Combined Continuous Intravenous Sodium Infusion Therapy.","authors":"Akinori Yamaguchi, Atsuyoshi Mita, Kosuke Sonoda, Makoto Harada, Koji Hashimoto, Hiroshi Imamura, Yuji Kamijo","doi":"10.1002/1744-9987.70165","DOIUrl":"10.1002/1744-9987.70165","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>cIVNa may support hemodynamic stability and improve RRT withdrawal and survival outcomes in patients requiring long-term CRRT.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"460-470"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Protein Intake and Peritoneal Protein Losses in Peritoneal Dialysis Patients.","authors":"Haalah Shaaker, Andrew Davenport","doi":"10.1002/1744-9987.70146","DOIUrl":"10.1002/1744-9987.70146","url":null,"abstract":"<p><strong>Introduction: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusion: </strong>Patients with faster protein clearance and protein losses had higher DPI.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"544-550"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic Plasma Exchange in Thailand: A 10-Year Retrospective Analysis.","authors":"Kornchanok Vareesangthip, Areerat Ounhasuttiyanon, Kritsada Pongsakornkullachart, Kitilak Rochaikun, Jiraporn Jitprapaikulsan, Sasitorn Siritho, Parichart Permpikul, Adisorn Lumpaopong, Kriengsak Vareesangthip","doi":"10.1002/1744-9987.70148","DOIUrl":"10.1002/1744-9987.70148","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":94253,"journal":{"name":"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","volume":" ","pages":"569-584"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}