PMID- 37605563 OWN - NLM STAT- MEDLINE DCOM- 20231106 LR - 20231106 IS - 1744-9987 (Electronic) IS - 1744-9979 (Linking) VI - 27 IP - 6 DP - 2023 Dec TI - Short term-efficacy and tolerability of Rheocarna, a novel direct hemoperfusion adsorptive column, for chronic limb-threatening ischemia in dialysis patients: A single-center case series. PG - 1010-1016 LID - 10.1111/1744-9987.14049 [doi] AB - INTRODUCTION: With population aging and lifestyle changes, the number of patients with chronic limb-threatening ischemia (CLTI) is increasing, and refractory or recurrent lesions are more common, especially in chronic dialysis patients. In March 2021, a new type of adsorptive cellulose bead column immobilized with dextran sulfate and L-tryptophan for direct hemoperfusion (DHP) was approved by Japan's medical insurance system as a treatment for CLTI. METHODS: We retrospectively analyzed 17 cases of CLTI in dialysis patients treated with DHP using the novel column (Rheocarna) (DHP-R) at our hospital from May 2021 to October 2022. The short-term of efficacy of DHP-R was judged qualitatively by the foot care team every 2 weeks based on the assessment of skin color, warmth, ulcer epithelialization or shrinkage of the ulcer area, and foot pain. The final judgment of efficacy was made after the final DHP-R session. RESULTS: The median age of patients was 66 years, the median dialysis duration was 10 years, 15 cases (88%) were male, and 15 cases (88%) had diabetes. The median total number of sessions was eight. In comparing the groups in which DHP-R was effective and ineffective, there was no significant difference in any factors including patient background data (i.e., age, diabetes, low-density lipoprotein cholesterol, hemoglobin, dialysis duration, etc.), type of anticoagulants, and presence of episodes of blood pressure drop or circuit clotting during session. Three cases with symptomatic hypotension during the session and two cases with circuit clotting that did not improve with increased heparin dose all resolved immediately after changing the anticoagulant from heparin to nafamostat mesylate (NM). CONCLUSION: Identification of patients' characteristics in which DHP-R is favorable and some reliable index that allow a rapid decision to continue DHP-R are needed. In addition, validating whether the use of NM as anticoagulant affects the efficacy of DHP-R for CTLI treatment remains a challenge to resolve. CI - (c) 2023 International Society for Apheresis and Japanese Society for Apheresis. FAU - Imai, Eri AU - Imai E AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Kaneko, Shuzo AU - Kaneko S AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Hoshimoto, Ainori AU - Hoshimoto A AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Hisada, Rina AU - Hisada R AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Harano, Makiko AU - Harano M AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Anno, Emi AU - Anno E AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Hagiwara, So AU - Hagiwara S AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Ozaki, Shunsuke AU - Ozaki S AD - Department of Cardiology, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Torii, Hiroko AU - Torii H AD - Department of Plastic surgery, Itabashi-Chuo Medical Center, Tokyo, Japan. FAU - Tsukamoto, Yusuke AU - Tsukamoto Y AD - Department of Nephrology, Itabashi-Chuo Medical Center, Tokyo, Japan. LA - eng PT - Journal Article DEP - 20230821 PL - Australia TA - Ther Apher Dial JT - 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 JID - 101181252 RN - J2VZ07J96K (Polymyxin B) RN - 0 (Anti-Bacterial Agents) RN - 0 (Anticoagulants) RN - 9005-49-6 (Heparin) SB - IM MH - Humans MH - Male MH - Aged MH - Female MH - Polymyxin B MH - Anti-Bacterial Agents/therapeutic use MH - Chronic Limb-Threatening Ischemia MH - Retrospective Studies MH - *Hemoperfusion MH - Ulcer/drug therapy/etiology MH - Renal Dialysis MH - Anticoagulants/therapeutic use MH - Heparin MH - *Diabetes Mellitus/drug therapy MH - Treatment Outcome OTO - NOTNLM OT - LDL apheresis OT - Rheocarna OT - chronic limb-threatening ischemia (CLTI) OT - nafamostat mesylate (NM) EDAT- 2023/08/22 06:42 MHDA- 2023/11/06 06:43 CRDT- 2023/08/22 03:12 PHST- 2022/12/28 00:00 [received] PHST- 2023/02/22 00:00 [accepted] PHST- 2023/11/06 06:43 [medline] PHST- 2023/08/22 06:42 [pubmed] PHST- 2023/08/22 03:12 [entrez] AID - 10.1111/1744-9987.14049 [doi] PST - ppublish SO - Ther Apher Dial. 2023 Dec;27(6):1010-1016. doi: 10.1111/1744-9987.14049. Epub 2023 Aug 21.