Wikdahl Am

Access in Therapeutic Apheresis

Abstract:  Various modes may be used to perform apheresis, such as plasma exchange, plasmapheresis, immunoadsorption, and blood perfusion. The vascular access used for acute procedures may be sufficiently supplied by two peripheral veins or catheters placed in the femoral vein or the right internal jugular vein. For chronic treatment it might be necessary to place an arteriovenous fistula or graft. The risks involved when using the various accesses is discussed, as is the insertion technique of the femoral vein catheter. The insertion of catheters into larger vessels is preferably controlled by ultrasound guidance. The incidence of adverse events due to access problems is about 0.4%. Once in every 1000 planned procedures, a problem with the access will cause an interruption of apheresis. Other complications that may occur are infections and thrombosis. Long‐term use of particularly subclavian vein catheters more frequently results in stenosis than the use of other accesses. The placement of a femoral vein catheter is facilitated by outward rotation of the leg. In addition, other practical suggestions are given.

Safety and efficacy of atorvastatin in patients with severe renal dysfunction

Objective. To investigate the efficacy and safety of a daily dose of 10 mg of atorvastatin in patients with chronic kidney disease (CKD) stages 4 and 5 and a glomerular filtration rate of <30 ml/min. Material and methods. This was an open, prospective, randomized study. A total of 143 patients were included: 73 were controls and 70 were prescribed 10 mg/day of atorvastatin. As efficacy variables, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglyceride levels were determined at the start of the study and at 1, 3, 6, 12, 18, 24, 30 and 36 months. Results. The follow-up period was a mean of 20±14.4 months (range 1–36 months) for those on atorvastatin versus 22±12.7 months (range 0.5–36 months) for the controls. Compared with baseline values, patients treated with atorvastatin had significantly lower concentrations of total cholesterol at Month 36 (5.8 vs 4.4 mmol/l; −23%; p<0.001), of LDL cholesterol at Month 36 (3.6 vs 2.2 mmol/l; −35%; p<0.001) and of triglycerides at Months 24 (2.5 vs 1.9 mmol/l) and 36 (2.5 vs 1.8 mmol/l). The controls had significantly reduced levels of total cholesterol at Month 36 (p<0.21) and of LDL cholesterol at Months 30 and 36. Compared with the controls, the atorvastatin group had lower levels of total cholesterol and LDL cholesterol at Months 1–30. Fifteen patients (21%) stopped taking their medication as they could not tolerate the side-effects, the most frequent complaints being gastrointestinal discomfort and headache. Conclusion. Although the medication caused no severe adverse events, we recommend caution when using atorvastatin for severe CKD patients until further evidence of its safety and efficacy is verified.