Therapeutic Apheresis and Dialysis via MedWorm.com

Ultrasonographic Detection of Thyroid Nodules in Hemodialysis Patients in Japan

Therapeutic Apheresis and Dialysis — Fri, 05 Mar 2010 00:00:00 +0100

In conclusion, patients undergoing hemodialysis frequently develop thyroid abnormalities and ultrasonography is a useful imaging modality to identify these lesions. (Source: Therapeutic Apheresis and Dialysis)

RheoNet Registry Analysis of Rheopheresis for Microcirculatory Disorders With a Focus on Age-related Macular Degeneration

Therapeutic Apheresis and Dialysis — Thu, 04 Mar 2010 00:00:00 +0100

The purpose of establishing the RheoNet registry was to evaluate the safety and efficacy of rheopheresis, a specific method of therapeutic apheresis used to treat microcirculatory disorders. Apheresis centers providing rheopheresis therapy and physicians caring for the underlying disease were asked to participate in the registry, and the registry data were analyzed for safety and tolerability. Age-related macular degeneration (AMD) was selected as a model disease to evaluate efficacy. The RheoNet registry was successfully established recording 7722 rheopheresis treatments of 1110 patients, including 833 AMD patients. The mean age of patients was 72 years. Adverse events (AE) were reported in 5.67% of treatments, but termination of the treatment session was only required in 0.48%. Transient...

Virus Removal and Eradication by Modified Double Filtration Plasmapheresis Decreases Factor XIII Levels

Therapeutic Apheresis and Dialysis — Thu, 04 Mar 2010 00:00:00 +0100

Factor XIII (FXIII) deficiency increases the chance for pathological bleeding, but this disorder cannot be detected by routine laboratory tests. Virus removal and eradication (VRAD, the trademark of Asahikasei Kuraray Medical) by double filtration plasmapheresis (DFPP) is an effective technique used to eradicate the hepatitis C virus in people afflicted with the disease. We have previously reported that DFPP significantly reduced FXIII in those undergoing this treatment. VRAD is a modified type of DFPP with a larger pore size of the second filter compared to conventional DFPP. Because VRAD may have similar effects on FXIII levels, we investigated the kinetics of FXIII during the course of VRAD therapy. A retrospective, observational study of the patients who underwent VRAD between July 200...

Impact of Serum Apolipoprotein A-IV as a Marker of Cardiovascular Disease in Maintenance Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Thu, 04 Mar 2010 00:00:00 +0100

The aim of this study was to investigate the relationship between serum apolipoprotein (apo) A-IV levels and markers for atherosclerosis, including carotid intima-media thickness (CIMT) and the ankle[ndash]brachial index (ABI), in hemodialysis patients. We performed a cross-sectional study involving 116 maintenance hemodialysis patients (70 males; median age, 64 years), measuring CIMT, ABI, the usual laboratory examinations, and serum apo A-IV before the dialysis session. The apo A-IV concentration was measured by a noncompetitive ELISA. Serum apo A-IV concentrations were significantly lower in hemodialysis patients with cardiovascular disease and plaque in the carotid artery. The apo A-IV level was positively associated with urea nitrogen and creatinine, and negatively associated with age...

Effects of Eicosapentaenoic Acid Supplementation on Immunoglobulin A Nephropathy

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

Eicosapentaenoic acid (EPA), which is purified from fish oil, attenuates inflammatory responses by decreasing eicosanoid and cytokine production. EPA reportedly improves renal survival in patients with immunoglobulin (Ig)A nephropathy; however, this is unconfirmed. We studied the effects of EPA on IgA nephropathy patients. Eighteen biopsy-confirmed IgA nephropathy patients (aged 31 ± 3 years) were enrolled. The prognoses based on glomerular findings were good (N = 5), relatively poor (N = 12), and poor (N = 1). EPA was administered at 1.8 g/day for 12 months. Five biopsy-confirmed IgA nephropathy patients were enrolled as control subjects. Administration of other drugs used to treat IgA nephropathy was not changed. The estimated creatinine clearance (eCCr), serum creatinine (Cr) concentra...

Plasma Exchange in Elderly Patients

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

Plasma exchange (PE) is an extracorporeal blood purification technique designed for the removal of large molecular weight substances from plasma. Data regarding the use of PE in elderly patients is lacking, so this study analyzes the database of the Department of Dialysis at the University Hospital Center Zagreb (634 patients, 6237 procedures) for indications and complications in patients aged 65 years or older who were submitted to PE during the period from 1982 to 2007. A total of 50 patients in this age group were submitted to PE; their median age was 69 years (range 65[ndash]83). This population underwent 323 episodes of PE, mostly with albumin solution as the replacement fluid (94.0%), and blood access was usually via peripheral veins (72.0%). The most common indication for therapy (7...

Treatment of Steroid Unresponsive Relapse With Plasma Exchange in Aggressive Multiple Sclerosis

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

This study further supports the efficacy of plasma exchange in the treatment of steroid unresponsive relapses in aggressive RRMS. (Source: Therapeutic Apheresis and Dialysis)

Low-density Lipoprotein Apheresis by Membrane Differential Filtration (Cascade Filtration) via Arteriovenous Fistula Performed in Children With Familial Hypercholesterolemia

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

In this study, we aim to discuss the efficacy of low-density lipoprotein (LDL) apheresis performed by providing alternative vascular routes in two siblings with familial hypercholesterolemia who did not respond to medical treatment and diet. Of the two siblings, one was nine years old and the other one was three-and-a-half years old. Of the total of 78 apheresis processes performed, 24 were done via a permanent subclavian catheter, 36 were done via a subsequently provided arteriovenous fistula, and 18 were done via an arteriovenous graft. We observed a mean reduction in the plasma levels of total cholesterol (61.6%), LDL cholesterol (65.5%), and high-density lipoprotein cholesterol (38.6%). We noted that cascade filtration apheresis was effective in decreasing the LDL cholesterol in plasma...

Impact of Fibroblast Growth Factor 23 on Lipids and Atherosclerosis in Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

Levels of fibroblast growth factor (FGF) 23, a phosphatonin, are frequently elevated in patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (MHD). However, the role of FGF23 remains unclear because renal FGF receptor function might be impaired. The present cross-sectional study examines a cohort of patients (n = 196) on MHD who were not undergoing therapy with lipid-lowering drugs including sevelamer. Non-fasting venous blood samples were withdrawn before the hemodialysis (HD) session on the third day after the previous HD session to measure serum levels of albumin, calcium (Ca), phosphate (P), alkaline phosphatase, intact parathyroid hormone (PTH), total cholesterol (C), high-density lipoprotein (HDL)-C, low-density lipoprotein(LDL)-C, oxidative LDL-C, high-se...

Occult Hepatitis B Virus Infection in Hemodialysis Patients With Isolated Hepatitis B Core Antibody: A Multicenter Study

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable hepatitis B surface antigen (HBsAg). Occult HBV infection harbors potential risk of HBV transmission through hemodialysis (HD). The aim of this study was to assess the occult HBV infection in hemodialysis patients with isolated hepatitis B core antibody (anti-HBc). A total of 289 HD patients from five dialysis units in Tehran, Iran, were included in this study. Hepatitis B surface antigen (HBsAg), Hepatitis B surface antibody (anti-HBs), anti-HBc, Hepatitis C antibody (anti-HCV), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of HD patients with isolated anti-...

Beneficial Therapeutic Effect of Plasmapheresis After Unsuccessful Treatment With Corticosteroids in Two Patients With Severe Toxic Epidermal Necrolysis

Therapeutic Apheresis and Dialysis — Wed, 20 Jan 2010 00:00:00 +0100

We present two patients with severe TEN (both with >80% body skin surface involvement) treated unsuccessfully with corticosteroids followed by plasmapheresis. Plasmapheresis led to prompt improvement, with extensive reepithealization of the skin, and eventually total recovery of both patients. In severe TEN unresponsive to corticosteroids, treatment with plasmapheresis should be considered. (Source: Therapeutic Apheresis and Dialysis)

Parathyroid Gland Ultrasound Patterns and Biochemical Findings After One-year Cinacalcet Treatment for Advanced Secondary Hyperparathyroidism

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

Cinacalcet efficacy is limited in severe secondary hyperparathyroidism (SHPT) and its effect on parathyroid gland (PTG) volume and morphology have not been sufficiently investigated. We evaluated the effect of cinacalcet treatment for one year on the laboratory parameters of calcium[ndash]phosphorus metabolism and PTG ultrasound (US) patterns in hemodialysis (HD) patients with severe SHPT and US results indicative of nodular hyperplasia. Thirteen HD patients with severe SHPT (intact parathyroid hormone >700 pg/mL), US/scintigraphic evidence of at least one PTG with a diameter >7 mm, and high surgical risk or refusal of surgery were included. The patients were treated with cinacalcet. The initial dose of 30 mg was increased up to 180 mg once daily. At baseline and after one year of cinacalc...

Relationship of Skin Autofluorescence to Cardiovascular Disease in Japanese Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

Advanced glycation end products (AGE) are significantly increased in end-stage renal disease patients and it has been suggested that AGE accumulation is related to the progression of cardiovascular disease. An autofluorescence reader non-invasively assesses AGE accumulation using skin autofluorescence under ultraviolet light. Skin autofluorescence has been reported to be an independent predictor of mortality in Caucasian hemodialysis patients. The aim of this study was to assess whether skin autofluorescence in Japanese hemodialysis patients is related to the presence of cardiovascular disease. In this cross-sectional study, patients on maintenance hemodialysis (N = 128; 59 men, 69 women) were included. AGE accumulation was assessed by skin autofluorescence using an autofluorescence reader...

How Does Short-term Low-dose Simvastatin Influence Serum Prohepcidin Levels in Patients With End-stage Renal Disease? A Pilot Study

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

In this study, we applied simvastatin for the purpose of influencing serum prohepcidin level in a group of maintenance hemodialysis patients. Thirty-three ESRD patients undergoing hemodialysis were enrolled and assigned to experimental and hemodialysis control groups according to their lipid profile. Nineteen healthy adults were chosen as a normal control group. The subjects in the experimental group took 20 mg simvastatin orally per night for eight weeks, and those in the hemodialysis control group took no statins or any other lipid-modulating drugs. Before and after the experiment, the serum prohepcidin concentrations, plasma IL-6, and serum C-reactive protein (CRP), ferritin, hemoglobin, albumin, total cholesterol, glycerinate, and LDL and HDL cholesterol levels were determined. Of the ...

Positive Dialysate Gram Stain Predicts Outcome of Empirical Antibiotic Therapy for Peritoneal Dialysis-associated Peritonitis

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

Empirical antibiotic treatment with a first-generation cephalosporin plus gentamicin for peritoneal dialysis (PD)-associated peritonitis before culture results are available is still wildly used due to concerns regarding the economic burden and antibiotic-resistant bacterial infections. The aim of this study is to define the factors that predict the outcome of empirical antibiotic therapy for PD peritonitis. This is a retrospective study of patients with PD peritonitis over the last 10 years. Patients who had been treated empirically with intermittent intraperitoneal first-generation cephalosporin and gentamicin were enrolled. Eighty-three patients had 192 episodes of PD peritonitis. In total, 159 peritonitis episodes were treated with intraperitoneal antibiotics combined with first-genera...

Serum Antioxidant Capacity is Preserved in Peritoneal Dialysis Contrary to Its Robust Depletion After Hemodialysis and Hemodiafiltration Sessions

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

This study was designed to assess the magnitude of the impairment of serum total antioxidant capacity (TAC) in relation to different RRT modalities. The study included patients on continuous ambulatory peritoneal dialysis (CAPD, N = 21), hemodialysis (HD, N = 21), hemodiafiltration (HDF, N = 20), and healthy controls (N = 33). TAC was assessed by the ferric reducing ability of plasma (FRAP) and with the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) assay. In CAPD patients, predialysis FRAP and DPPH were increased: 1.46 mM and 10.5% vs. control 1.19 mM and 7.2%, respectively (P < 0.001 in each). In HD and HDF patients, the FRAP and DPPH were significantly increased before and lowered after the RRT session (P < 0.05) if compared with healthy controls. During an HD session, FRAP was decreased from pr...

Labile Plasma Iron Generation After Intravenous Iron is Time-dependent and Transitory in Patients Undergoing Chronic Hemodialysis

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

Iron supplementation in hemodialysis patients is fundamental to erythropoiesis, but may cause harmful effects. We measured oxidative stress using labile plasma iron (LPI) after parenteral iron replacement in chronic hemodialysis patients. Intravenous iron saccharate (100 mg) was administered in patients undergoing chronic hemodialysis (N = 20). LPI was measured by an oxidant-sensitive fluorescent probe at the beginning of dialysis session (T0), at 10 min (T1), 20 min (T2), and 30 min (T3) after the infusion of iron and at the subsequent session; P < 0.05 was significant. The LPI values were significantly raised according to the time of administration and were transitory: [minus]0.02 ± 0.20 µmol/L at the beginning of the first session, 0.01 ± 0.26 µmol/L at T0, 0.03 ± 0.23 µmol/L at T...

Two Variable Sodium Profiles and Adverse Effects During Hemodialysis: A Randomized Crossover Study

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

Intradialytic symptomatic hypotension and muscle cramps are frequent and disturbing adverse effects involving hemodialysis patients. The use of sodium profiling has been a proposed approach to preclude such events. The aim of the study was to compare the frequency of intradialytic adverse effects and changes in anthropometric and physiological variables without profiling and with two distinct sodium profiles. A prospective study randomized 22 stable hemodialysis patients to receive either a step (11 patients) or a linear (11 patients) dialysate sodium profile for 12 consecutive sessions, following a 12-session steady sodium control period. After a wash-out period of 12 sessions, the groups were crossed over for another 12-session period. Frequency of adverse effects, interdialytic weight g...

Peritonitis Associated With Pasteurella multocida: Molecular Evidence of Zoonotic Etiology

Therapeutic Apheresis and Dialysis — Fri, 18 Dec 2009 00:00:00 +0100

A patient on continuous cyclic peritoneal dialysis for chronic kidney disease due to type 2 diabetes mellitus developed peritoneal dialysis-associated peritonitis induced by Pasteurella multocida that was isolated from a sample of dialysis effluent. The route of infection was unknown for this case; however, P. multocida was also isolated from a culture of a pharyngeal swab obtained from the patient's cat. There was no evidence that the cat had bitten and ruptured the peritoneal dialysis tubing or bags. Pulsed-field gel electrophoresis (PFGE) showed that the P. multocida isolated from the patient was completely identical to the strain isolated from the domestic cat. As there is a rise in the pet-keeping population, an increase in zoonoses is to be expected. It is necessary to be carefully i...

Lessons From Single Cell Organisms: Insights Into the Antimicrobial and Toxic Effects of Peritoneal Dialysate Bases

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

Although it was first described over a quarter of a century ago, the mechanisms behind the antimicrobial activity of fresh peritoneal dialysate have been poorly understood. Recent insight into the biochemistry appears to suggest that at least part of the effect resides in the salts of the carboxylic acids. An understanding of the metabolic pathways of both sensitive and resistant organisms has not only led to an understanding of the mechanisms of the antimicrobial effect, but also may have provided the insight for future studies to reduce toxicity to the peritoneal membrane. While our knowledge base in this area is still evolving, an improved understanding of the biochemical basis of both the antibacterial effect and toxicity of the salts of carboxylic acids in peritoneal dialysate can onl...

Apheresis Induces Oxidative Stress in Blood Cells

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

Oxidative stress mediates damage to various cells and is thought to be involved in various pathologies, including hereditary and acquired hemolytic anemias. It is induced by a multitude of physiological and environmental factors, including extracorporeal manipulation of blood. As a result, hemodialysis induces oxidative damage to red blood cells, thereby increasing their susceptibility to hemolysis and shortening their life span. We studied the effect of apheresis on the oxidative status of blood components. Using flow cytometric measurements, we showed that red blood cells, lymphocytes, monocytes, and polymorphonuclear cells undergo oxidative stress induced by the procedure. Their reactive oxygen species and externalization of phosphatidylserine increased, while their levels of reduced gl...

Retrospective Analysis of Long-term Lipid Apheresis at a Single Center

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

We retrospectively analyzed 10 906 lipid apheresis sessions (heparin-induced lipoprotein precipitation, direct adsorption of lipoproteins, double filtration plasmapheresis, dextran sulfate adsorption, and immunoadsorption) in 38 patients who were consecutively treated in our department during the last 20 years. The incidences of major cardiovascular events (MACE) (death, cerebrovascular accident, myocardial infarction, limb amputation, and renal vascular involvement) were taken separately as primary end-points or as a combined end-point. The time-course of secondary end-points (coronary and extracranial status of arteries, left ventricular function, occlusive artery disease, and calculated glomerular filtration rate [cGFR]) were also evaluated, as well as the extent of the reduction in pla...

Does Concomitant Administration of Sevelamer and Calcium Carbonate Modify the Control of Phosphatemia?

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

There is no guideline regarding the concomitant or distant administration of sevelamer and calcium carbonate. Our aim was to determine whether serum phosphate varied when sevelamer and calcium carbonate were administered concomitantly in comparison to administration at separate meals. Fourteen chronic hemodialysis patients were enrolled in this cross-over, randomized trial. Each subject underwent two four-week study periods. During the "concomitant" period, subjects were instructed to take both sevelamer and calcium carbonate together at each meal, whereas in the "separate" period, they were required to take them at separate meals. The order of the "concomitant" and "separate" periods was randomized. Phosphate-binding agents were stopped for a one-week washout period before each study peri...

Physical Activity Is Necessary to Prevent Deterioration of the Walking Ability of Patients Undergoing Maintenance Hemodialysis

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

Maintenance of the walking ability is very important for smooth continuation of maintenance hemodialysis (HD). The aim of the present study was to clarify the physical activity level in daily living that HD patients should maintain to prevent deterioration of their walking ability. Outpatients undergoing maintenance HD, consisting of 65 males and 88 females with a mean age of 64 ± 11 years, were recruited for the present study. Their physical activity level was recorded over a week with an accelerometer. The physical activity level in daily living was defined as the sum of the lengths of time for which the patients were engaged in physical activity of light or greater intensity during the day, and expressed as the average duration per day. The walking ability was assessed by the normal wa...

Comparing the Autoantibody Levels and Clinical Efficacy of Double Filtration Plasmapheresis, Immunoadsorption, and Intravenous Immunoglobulin for the Treatment of Late-onset Myasthenia Gravis

Therapeutic Apheresis and Dialysis — Fri, 30 Oct 2009 00:00:00 +0100

The aim of this study was to investigate the effects of double-filtration plasmapheresis (DFPP), immunoadsorption (IA) and intravenous immunoglobulin (IVIg) in the treatment of late-onset myasthenia gravis (MG). A total of 40 late-onset MG patients were randomly divided into three groups: 15 patients were treated with DFPP; 10 patients were treated with IA; and 15 patients received IVIg. The titers of titin antibodies (Titin-ab), acetylcholine receptor antibodies (AChR-ab), presynaptic membrane antibody (Prsm-ab) were detected before and after the treatment, and the quantitative MG score (QMG score) was assessed by blinded examiners before and immediately after the entire course of treatment. The clinical efficacy, duration of respiratory support, hospital stay, and the correlation between...

Cell-free DNA in the Peritoneal Effluent of Peritoneal Dialysis Solutions

Therapeutic Apheresis and Dialysis — Tue, 11 Aug 2009 23:00:00 +0100

The beneficial effects of novel peritoneal dialysis solutions low in glucose degradation products regarding peritoneal cell apoptosis and necrosis are well established in vitro, however in vivo data is lacking. Cell-free DNA quantification is a possible method to determine cell damage through apoptosis and necrosis in vivo. We performed a prospective, cross-over study on 26 stable continuous ambulatory peritoneal dialysis (CAPD) patients, treating each patient for 3 months in a randomized order with a conventional, lactate-buffered, acidic solution (solution D) and a novel, bicarbonate/lactate-buffered neutral solution (solution P). The timed overnight peritoneal effluent was sampled for cell-free DNA quantification using a fluorometric assay. The effluent samples of eighteen patients were...

Effects of Dialysis Purity on Uremic Dyslipidemia

Therapeutic Apheresis and Dialysis — Mon, 10 Aug 2009 23:00:00 +0100

Dyslipidemia, a prominent feature of end-stage renal disease, is considered a risk factor for premature atherosclerosis in hemodialysis (HD) patients. Dyslipidemia is related to loss of kidney function as well as use of low-flux cellulosic dialyzer membranes, but the effects of dialysate purity are unknown. Forty-eight incident HD patients started high-flux polysulfone maintenance HD, either with conventional (potentially contaminated) or with on-line produced ultrapure dialysate. The quality of the dialysis fluid (CFU/mL, endotoxin concentration), markers of inflammation (C-reactive protein, Il-6), and parameters of the lipid profile and oxidative stress (oxidized low-density lipoprotein) were measured before initiation of HD, and after 6, 12 and 24 months on HD. Compared to baseline, tre...

Low-Density Lipoprotein Apheresis Decreases Ferritin, Transferrin and Vitamin B12, Which May Cause Anemia in Serially Treated Patients

Therapeutic Apheresis and Dialysis — Mon, 10 Aug 2009 23:00:00 +0100

Clinical observations revealed an increased prevalence of iron deficiency anemia without chronic bleeding in patients treated with serial low-density lipoprotein (LDL) apheresis. Since several different proteins are adsorbed by LDL apheresis beside pro-atherogenic lipoproteins, we examined the modification of the full blood count, plasma iron, vitamin B12, folic acid, and hemolysis by LDL apheresis. Nineteen patients (55 (50[ndash]59) years, 4 female, 15 male) undergoing chronic LDL apheresis due to mixed dyslipidemia (N = 17), homozygous familiar hypercholesterolemia (N = 1) or isolated elevated lipoprotein(a) (N = 1) were included in this study. They were treated with direct adsorption of lipoproteins (DALI; N = 6), heparin-induced LDL-precipitation (HELP; N = 7) or double filtration pla...

Apheresis Technologies and Clinical Applications: The 2007 International Apheresis Registry

Therapeutic Apheresis and Dialysis — Mon, 10 Aug 2009 23:00:00 +0100

The developments in apheresis technologies and techniques and their clinical applications worldwide are technologically, sociologically, and economically motivated. As in the past apheresis surveys, the statistics have highlighted both the differences by geographic region in clinical practice and in the type of technologies utilized. While a national view of apheresis is very important, an international view may be more representative overall of this therapeutic modality than national results that are highly dependent on the local economics and the available technologies. These regional differences have provided a basis for scientific and clinical assessment of these apheresis technologies and their clinical outcomes, and have impacted the marketing and business developments of new technol...

Connective Tissue Growth Factor Knockdown Attenuated Matrix Protein Production and Vascular Endothelial Growth Factor Expression Induced by Transforming Growth Factor-β1 in Cultured Human Peritoneal Mesothelial Cells

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

This study suggests that downregulation of CTGF may represent a potential therapeutic approach for peritoneal fibrosis through decreasing ECM accumulation and angiogenesis. (Source: Therapeutic Apheresis and Dialysis)

15-Deoxy-Δ12,14-prostaglandin J2 Inhibits Angiotensin II-induced Fibronectin Expression via Hepatocyte Growth Factor Induction in Human Peritoneal Mesothelial Cells

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

15-Deoxy-[Delta]12,14-prostaglandin J2 (15d-PGJ2) is an endogenous peroxisome proliferator-activated receptor [gamma] (PPAR[gamma]) agonist that suppresses progressive matrix deposition; however, little is known about the effects of 15d-PGJ2 on human peritoneal mesothelial cells (HPMCs). We investigated the following: (i) the expression of PPAR[gamma]; (ii) the effect of 15d-PGJ2 on angiotensin II (Ang II)-induced fibronectin (FN) expression and secretion; (iii) the effect of 15d-PGJ2 (with or without Ang II and with or without the specific PPAR[gamma] antagonist GW9662) and pioglitazone, a synthetic PPAR[gamma] agonist, on hepatocyte growth factor (HGF) expression and secretion; (iv) the effect of HGF on Ang II-induced FN expression and secretion; (v) the expression of c-Met (a specific H...

Impact of Renal Survival on the Course and Outcome of Systemic Lupus Erythematosus Patients Treated With Chronic Peritoneal Dialysis

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

This longitudinal study investigated whether renal survival can affect the course and outcome of systemic lupus erythematosus (SLE) patients treated with chronic peritoneal dialysis (PD). Thirty-five SLE patients, out of 1115 end-stage renal disease (ESRD) patients treated with chronic PD, were seen between 1990 and 2007 at the Chang Gung Memorial Hospital. Patients were followed up for a mean of 38.8 ± 22.9 months. There were no significant differences between patients with short renal survival (3 years) for the various demographic variables such as age, sex, PD duration, immunosuppressive drug administration, or exchange system (P > 0.05). Interestingly, before PD, patients with short renal survival had lower serum complement levels than patients with long renal survival (C3, 40.2 ± 14...

Italian Multicenter Study on Low-Density Lipoprotein Apheresis: Retrospective Analysis (2007)

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

A retrospective study[mdash]the Italian Multicenter Study on Low-density Lipoprotein Apheresis (IMS-LDLa)[mdash]was carried out, which involved 19 centers for LDLa in Italy, distributed all over the country[mdash]in the north, center, south, and the major islands. The survey was conducted through two consecutive questionnaires, which can be downloaded online from a dedicated site. The total number of procedures performed until 2007 was 31 012, and the number of patients undergoing treatment until 2007 were 229. The treated patients still surviving consisted of 136 (74 males and 62 females); those surviving but not treated numbered 95, and those deceased numbered 14. The techniques utilized, listed by frequency of use, were the following: dextran sulfate cellulose adsorption, direct adsorpt...

Acute and Subacute Effect of Rheopheresis on Microvascular Endothelial Function in Patients Suffering From Age-related Macular Degeneration

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

This study was performed on seven patients affected by the atrophic form of age-related macular degeneration (AF-ARMD). The patients under investigation belonged to a larger study aimed at evaluating the efficacy of rheopheresis treatment (RT) on the visual function of AF-ARMD patients. Following the protocol of the larger study, patients received RT twice a week, every two weeks, for a total of ten treatments, as well as high-dose supplementation with zinc and vitamins A, E and beta-carotene. Recruited patients underwent skin laser Doppler flowmetry coupled with skin iontophoresis of the endothelium-dependent vasodilator acetylcholine (ACh) and a test of skin post-ischemic reactive hyperemia, before and after the first RT (time 1: all seven patients) and the fifth RT (time 2: six patients...

Liver Transplantation Avoided in Patients With Fulminant Hepatic Failure Who Received Albumin Dialysis With the Molecular Adsorbent Recirculating System While on the Waiting List: Impact of the Duration of Therapy

Therapeutic Apheresis and Dialysis — Thu, 16 Jul 2009 23:00:00 +0100

Eighteen patients with fulminant hepatic failure due to various medical causes were listed for emergency liver transplantation and treated with extracorporeal albumin dialysis sessions using the molecular adsorbent recirculating system (MARS) at our center over a 74-month period. Due to improvement of liver function, transplantation could be avoided in 9 patients (50%, 95% confidence interval 29% to 71%) who fully recovered afterwards. This improvement rate was higher than the rate of improvement in the French cohort of fulminant hepatic failure patients with similar etiologies (19.3%, 95% confidence interval 14.9% to 24.6%, P = 0.002). In our 18 patients, there were no statistically significant differences in any baseline characteristics or in the time with liver failure meeting transplan...

One Year Efficacy and Safety of Lanthanum Carbonate for Hyperphosphatemia in Japanese Chronic Kidney Disease Patients Undergoing Hemodialysis

Therapeutic Apheresis and Dialysis — Tue, 16 Jun 2009 04:00:00 +0100

This study provides further evidence that the administration of LaC over a period of one year is safe and effective for the reduction of serum phosphate levels in CKD patients undergoing hemodialysis. (Source: Therapeutic Apheresis and Dialysis)

Comparison of Different Low Density Lipoprotein Apheresis Machines on Brain Natriuretic Peptide Levels in Patients With Familial Hypercholesterolemia

Therapeutic Apheresis and Dialysis — Mon, 15 Jun 2009 04:00:00 +0100

In conclusion, LDL apheresis therapy, possibly through its immediate improvement of vascular flow and/or removal of the peptide from plasma, results in a significant reduction of BNP levels. The increased reduction of BNP by HELP may result from its superior acute alterations of rheological markers. (Source: Therapeutic Apheresis and Dialysis)

Poor Glycemic Control is a Significant Predictor of Cardiovascular Events in Chronic Hemodialysis Patients With Diabetes

Therapeutic Apheresis and Dialysis — Wed, 27 May 2009 01:39:05 +0100

We investigated the impact of glycemic control on the emergence of cardiovascular disease (CVD) in diabetic patients who were on maintenance hemodialysis in a prospective observational study. One hundred and thirty-four diabetic hemodialysis patients (63 ± 10 years-old, hemodialysis duration of 4.5 ± 3.9 years) at a single dialysis center were enrolled. The cohort was observed prospectively for 5 years, and the emergence of fatal and non-fatal CVD was recorded. Patients were categorized into two groups; good (mean hemoglobin (Hb) A1C (Source: Therapeutic Apheresis and Dialysis)

Planning a Social Activity to Improve Psychological Well-being and Quality of Life of Hemodialysis Patients: A Pilot Study

Therapeutic Apheresis and Dialysis — Tue, 26 May 2009 04:00:00 +0100

We aimed to investigate the impact of social activity on anxiety-depression, self-esteem and quality of life in hemodialysis patients. Ninety-one patients were recruited to the current study. Of these, 31 patients wanted to take part in a theater play, while 60 patients (group C) did not. Thirty-one patients were randomly assigned to two groups: Group A (N = 15) started activities immediately and group B (N = 16) was assigned to a waiting list to be included in the activity of theater acting four months later. Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-esteem Scale and World Health Organization Quality of Life Scale short form (WHOQOL-BREF) were used to compare psychological parameters and quality of life of the groups before and after the social activity. The patien...

Periodic Therapeutic Plasma Exchange in Patients With Moderate to Severe Chronic Myasthenia Gravis Non-Responsive to Immunosuppressive Agents: An Eight Year Follow-Up

Therapeutic Apheresis and Dialysis — Tue, 21 Apr 2009 04:00:00 +0100

We present our experience with periodic therapeutic plasma exchange (TPE), in 11 patients with MG resistant to intravenous immunoglobulin (IVIg) therapy, who had frequent relapses even whilst on high doses of immunosuppressive drugs, over a period of 8 years. All patients underwent TPE until control of their symptoms was achieved, and afterwards TPE sessions were continued periodically in an attempt to achieve remission of the disease, without immunosuppressant therapy. Two of the patients were progressively weaned off immunosuppressive agents, as well as TPE, and they are now symptom free. The other nine patients are still under a periodic TPE regime. Seven of them were weaned off all medications and required an average of 3.7 TPE sessions per year during the last 5 years. In the other tw...

A Case Report of Efficiency of Double Filtration Plasmapheresis in Treatment of Goodpasture's Syndrome

Therapeutic Apheresis and Dialysis — Tue, 21 Apr 2009 04:00:00 +0100

Goodpasture's syndrome is characterized by pulmonary hemorrhage, rapid progressive glomerulonephritis and the presence of anti-glomerular basement membrane (anti-GBM) antibodies. Here, we report a case of Goodpasture's syndrome that we treated with double filtration plasmapheresis (DFPP) combined with immunosuppression therapy. The patient was a 32-year-old man with the main complaints of low-grade fever, general fatigue and dyspnea. The clinical diagnosis was renal-pulmonary syndrome based on pulmonary hemorrhage on chest X-ray, rapid progressive renal insufficiency, and elevated C-reactive protein (CRP). Goodpasture's syndrome was diagnosed because the patient was negative for MPO-ANCA and PR3-ANCA, and positive for anti-GBM antibodies. Renal biopsy showed crescentic glomerulonephritis. ...

Hemodialysis Versus Peritoneal Dialysis: A Case Control Study of Survival in Patients With Chronic Kidney Disease Stage 5

Therapeutic Apheresis and Dialysis — Sat, 18 Apr 2009 04:00:00 +0100

It is still controversial whether the mode of dialysis or preexisting comorbidities may influence the prognosis of patients with chronic kidney disease stage 5. Therefore, we performed a prospective case control study to evaluate whether the mode of dialysis may influence outcome. We found 25 cases on peritoneal dialysis (PD) treatment and 75 age and sex-matched controls on hemodialysis (HD) treatment for more than 3 months. Analysis was by intention-to-treat. During the follow up of 58 months, 6 out of 25 patients (24%) died in the PD group, whereas in the HD group 26 out of 75 patients (35%) died (relative risk 0.69 [95% CI 0.32 to 1.49]; P = 0.46). Survival was not significantly different between the groups as indicated by Mantel-Cox log-rank test (hazard ratio 0.52 [95% CI 0.25 to 1.10...

Zinc Deficiency Anemia and Effects of Zinc Therapy in Maintenance Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Fri, 17 Apr 2009 04:00:00 +0100

Quantitative adjuvant zinc therapy using polaprezinc was performed to examine the correlation between zinc concentration and anemia in maintenance hemodialysis patients to propose appropriate treatment. Anemia and serum zinc concentration were measured in 117 patients with chronic renal failure receiving outpatient maintenance hemodialysis at Tsuyama Chuo Kinen Hospital. Two bags of polaprezinc (containing zinc 34 mg/day) were administered to 58 patients with lower than normal zinc levels (Zn < 80 mg/dl) as adjuvant zinc therapy to assess anemia improvement. Zinc concentration and all anemia parameters showed significant positive correlation, indicating that anemia improves in patients with high serum zinc levels. Regarding the effects of adjuvant zinc therapy for improving anemia, hemoglo...

Efficacy of High-Throughput Leukocytapheresis for Rheumatoid Arthritis With a Reduced Response to Infliximab

Therapeutic Apheresis and Dialysis — Fri, 17 Apr 2009 04:00:00 +0100

Infliximab (INF), a tumor necrosis factor-alpha (TNF-[alpha]) inhibitor, is an effective drug for patients with rheumatoid arthritis (RA). However, some patients receive no clinical benefit, or the agents gradually lose their effect. Five sessions of high-throughput leukocytapheresis (LCAP) were given at a frequency of once a week using a Cellsorba CS-180S to four patients with a reduced response to INF. The clinical response to LCAP was evaluated using the 28-joint disease activity score with C-reactive protein (DAS28-CRP) and with the erythrocyte sedimentation rate (DAS28-ESR). DAS28-CRP decreased significantly from 5.8 ± 0.6 before LCAP to 3.9 ± 0.7 (P = 0.0182) at 1[ndash]2 weeks after completion of five sessions of LCAP, and DAS28-ESR decreased significantly from 6.4 ± 0.6 to 4.6 �...

C-C Chemokine Receptor 2 Expression by Circulating Monocytes Influences Atherosclerosis in Patients on Chronic Hemodialysis

Therapeutic Apheresis and Dialysis — Fri, 17 Apr 2009 04:00:00 +0100

Mortality from cardiovascular or cerebrovascular disease due to atherosclerosis is increased in patients on chronic hemodialysis. Monocyte chemoattractant protein-1 and its receptor, C-C chemokine receptor 2, play an important role in recruiting monocytes to atherosclerotic lesions. The relationship between atherosclerosis in hemodialysis patients and C-C chemokine receptor 2 expression is unknown. Fifty-six patients on chronic hemodialysis and 27 age- and sex-matched controls were enrolled. Serum levels of monocyte chemoattractant protein-1 and expression of C-C chemokine receptor 2 by circulating monocytes were determined. Atherosclerosis was evaluated from the carotid intima-media thickness and cardio-ankle vascular index. Serum levels of monocyte chemoattractant protein-1 and expressio...

Ionized Alkaline Water: New Strategy for Management of Metabolic Acidosis in Experimental Animals

Therapeutic Apheresis and Dialysis — Fri, 17 Apr 2009 04:00:00 +0100

Metabolic acidosis can occur as a result of either the accumulation of endogenous acids or loss of bicarbonate from the gastrointestinal tract or the kidney, which represent common causes of metabolic acidosis. The appropriate treatment of acute metabolic acidosis has been very controversial. Ionized alkaline water was not evaluated in such groups of patients in spite of its safety and reported benefits. So, we aimed to assess its efficacy in the management of metabolic acidosis in animal models. Two models of metabolic acidosis were created in dogs and rats. The first model of renal failure was induced by ligation of both ureters; and the second model was induced by urinary diversion to gut (gastrointestinal bicarbonate loss model). Both models were subjected to ionized alkaline water (or...

Target for Glycemic Control in Type 2 Diabetic Patients on Hemodialysis: Effects of Anemia and Erythropoietin Injection on Hemoglobin A1c

Therapeutic Apheresis and Dialysis — Wed, 01 Apr 2009 04:00:00 +0100

In hemodialysis (HD) patients the glycated hemoglobin (HbA1c) level may underestimate glycemic control. The aim of this study is to estimate accurate glycemic control in type 2 diabetic patients on HD. Type 2 diabetes patients (N = 87) who had been receiving maintenance HD for at least one year were enrolled. HbA1c and the percentage of glycated albumin relative to total the serum albumin (%GA) were measured in blood samples and the factors that affected the %GA/HbA1c ratio were examined. There were significant and positive correlations between the plasma glucose and either the HbA1c levels (r = 0.539, P < 0.01) or the %GA level (r = 0.520, P < 0.01). No relationship between the serum albumin levels and %GA levels was observed. A weekly dose of erythropoietin (EPO) was positively correlate...

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Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The ISFA wishes to acknowledge the following 2009 Corporate Sponsors (Source: Therapeutic Apheresis and Dialysis)

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Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

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Standard on Microbiological Management of Fluids for Hemodialysis and Related Therapies by the Japanese Society for Dialysis Therapy 2008

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The Committee of Scientific Academy of the Japanese Society for Dialysis Therapy (JSDT) proposes a new standard on microbiological management of fluids for hemodialysis and related therapies. This standard is within the scope of the International Organization for Standardization (ISO), which is currently under revision. This standard is to be applied to the central dialysis fluid delivery systems (CDDS), which are widely used in Japan. In this standard, microbiological qualities for dialysis water and dialysis fluids are clearly defined by endotoxin level and bacterial count. The qualities of dialysis fluids were classified into three levels: standard, ultrapure, and online prepared substitution fluid. In addition, the therapeutic application of each dialysis fluid is clarified. Since high...

Case Reports of the Use of Immunoadsorption or Plasma Exchange in High-risk Pregnancies of Women With Antiphospholipid Syndrome

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

Conventional treatment of antiphospholipid syndrome (APS) pregnancies with aspirin and/or heparin is sometimes unable to counteract maternal and/or fetal complications. In this article we report the cases of two patients who were unresponsive to conventional treatment for APS during their first pregnancy, and who were treated in the following pregnancy with plasma exchange and immunoadsorption respectively, in addition to conventional therapy. Both patients had a history of thrombotic events, a previous pregnancy loss at the 11th week of gestation and the same antiphospholipid antibody profile (lupus anticoagulant activity and high titers of immunoglobulin G (IgG) anti-[beta]2 glycoprotein I and IgG anticardiolipin antibodies). Patient 1 was treated from the fourth week of her second pregn...

A Case Report of Successful Long-term Relapse Control by Protein-A Immunoadsorption in an Immunosuppressive-treated Patient With End-stage Renal Disease Due to Wegener's Granulomatosis

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

A long-term female hemodialysis patient with end-stage renal disease due to Wegener's granulomatosis (WG) experienced a severe relapse when immunosuppressive therapy was switched from prednisone and cyclophosphamide to azathioprine maintenance therapy. Ten courses of protein A immunoadsorption therapy and switching immunosuppressive therapy to mycophenolate mofetil have proved to be very successful and free of side effects. The patient has fully recovered from all clinical WG symptoms and is still in remission ten months after the treatment. (Source: Therapeutic Apheresis and Dialysis)

A Case Report of Amitriptyline Poisoning Successfully Treated With the Application of Plasma Exchange

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

Amitriptyline is a very frequently prescribed antidepressant agent and is very often involved in attempted suicides. Amitriptyline intoxication necessitates primary therapeutic approaches that include gastric irrigation and recurrent administration of activated charcoal. In the case of pronounced anticholinergic findings, physostigmine is of proven benefit and hypertonic sodium bicarbonate can be used to shorten the QRS duration and AV interval. In cases of a comatosed state, hemoperfusion and plasma exchange can be used. In this case report we present a case of severe amitriptyline poisoning that we successfully managed with plasma exchange. We confirmed a 59.5% reduction in the amitriptyline plasma level in our patient after a single plasma exchange session. She was discharged by the thi...

Granulocyte and Monocyte Adsorption Apheresis Therapy Modulates Monocyte-Derived Dendritic Cell Function in Patients With Ulcerative Colitis

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The aim of this study was to elucidate the molecular mechanisms responsible for the therapeutic effects of granulocyte and monocyte adsorption apheresis (GMA). We investigated the alterations in circulating monocyte subsets and monocyte-derived dendritic cell (moDC) function after GMA therapy in ulcerative colitis (UC) patients. Eighteen patients with UC were enrolled: 14 patients were responders, and 4 patients were non-responders. Peripheral venous blood was obtained within 5 min before and 5 min after GMA therapy. Flow cytometric analysis for monocyte markers (CD14/CD16) was then performed. Monocyte-derived dendritic cells were obtained and alterations in their phenotype were analyzed by flow cytometry. Their function was also analyzed in a mixed lymphocyte reaction assay between allo-n...

Single Lipoprotein Apheresis Session Improves Cardiac Microvascular Function in Patients With Elevated Lipoprotein(a): Detection by Stress/Rest Perfusion Magnetic Resonance Imaging

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

In conclusion, cardiac magnetic resonance imaging detects subtle treatment-related changes in regional myocardial perfusion in patients with elevated Lp(a) and coronary artery disease undergoing lipoprotein apheresis. (Source: Therapeutic Apheresis and Dialysis)

Low Density Lipoprotein Apheresis in Pediatric Patients With Homozygous Familial Hypercholesterolemia

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

In conclusion, LDL apheresis, started under the age of eight years, combined with lipid-lowering drugs, provides a safe and effective lowering of the mean LDL-C levels in pediatric homozygous FH; and there are more problems with compliance for pediatric LDL apheresis than in the adult population. (Source: Therapeutic Apheresis and Dialysis)

Malnutrition–Inflammation Complex Syndrome and Hepatitis C in Maintenance Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

Protein-energy malnutrition and inflammation are among the leading causes of poor outcome in hemodialysis patients. Hepatitis C virus (HCV) infection is accompanied by elevated proinflammatory mediators, also found in dialysis patients with malnutrition[ndash]inflammation complex syndrome. We aimed to study the rate and characteristics of malnutrition[ndash]inflammation complex syndrome (MICS) in hemodialysis patients, especially those with hepatitis C. The study included 147 patients (mean age 55.1 ± 12.9 years), 24.5% of whom were HCV-positive, undergoing adequate hemodialysis three times a week for the last 52.7 ± 52.5 months. Parameters of nutrition and inflammation were investigated to evaluate MICS. HCV-positive vs. HCV-negative patients had significantly higher hematocrit (29.6 ±...

Plasmapheresis and Intravenous Immunoglobulin in Early Antibody-Mediated Rejection of the Renal Allograft: A Single-Center Experience

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The objective of this retrospective single center study was to evaluate two different approaches to AMR. We retrospectively evaluated data files from 936 patients who had undergone renal transplantation in 2002[ndash]2006. In 2002[ndash]2003, patients with AMR were treated with five plasmapheresis sessions (PP group, N = 13), and in 2004[ndash]2006 they received five plasmapheresis session along with intravenous immunoglobulin 0.5 g/kg (PP+IVIg group, N = 11). Twelve months of follow-up data was analyzed. First year graft survival was significantly higher in the PP+IVIg group than in the PP group (90.9% vs. 46.2%; P = 0.044); similarly, patient survival was higher in the PP+IVIg group (100% vs. 76.9%; P = 0.056). The incidence of infectious complications was similar in both groups. In re-b...

Risk Factors of Normal Ankle–Brachial Index and Low Toe–Brachial Index in Hemodialysis Patients

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The prevalence of peripheral arterial occlusive disease is high in patients with terminal renal failure, and it is a major problem in those on dialysis. A low ankle[ndash]brachial index (ABI) suggests the presence of arterial stenotic lesions between the aorta and the ankle joint, while a low toe[ndash]brachial index (TBI) suggests stenotic lesions between the aorta and the toes. Therefore, a normal ABI ([ge]0.9) and a low TBI ( (Source: Therapeutic Apheresis and Dialysis)

Hypoglycemia in Diabetic Patients Undergoing Chronic Hemodialysis

Therapeutic Apheresis and Dialysis — Thu, 26 Mar 2009 04:00:00 +0100

The aim of our study was to determine if different hypoglycemic therapies are associated with more frequent episodes of hypoglycemia in diabetes patients undergoing long-term hemodialysis. We conducted a prospective cohort study that included 102 diabetes patients who were undergoing long-term hemodialysis. The frequency of symptomatic hypoglycemic episodes, intradialytic hypotension, antihypertension medication, hypoglycemic therapy regimens, dialysate contents, and laboratory data were reviewed. The duration of follow-up was three months. Fifty-four (52.9%) patients were categorized as hypoglycemic and 48 (47.1%) patients as non-hypoglycemic. The serum albumin levels of the hypoglycemic and non-hypoglycemic patients were 3.18 ± 0.34 g/dL and 3.44 ± 0.33 g/dL respectively (P < 0.001). T...

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