EFFICACY OF A NOVEL LDL APHERESIS DEVICE RHEOCARNA IN DIALYSIS PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

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Abstract Title *

EFFICACY OF A NOVEL LDL APHERESIS DEVICE RHEOCARNA IN DIALYSIS PATIENTS WITH CHRONIC LIMB-THREATENING ISCHEMIA

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Co-author 1

Kunihiro Ishioka kunihirock@hotmail.co.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan *

Co-author 2

Takayasu Ohtake ohtake@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 3

Kei Ohmori 1998go258@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 4

Chika Shibuya e173039g@yokohama-cu.ac.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 5

Tomoki Tsukarahara ttsukahara1112@gmail.com Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 6

Mizuki Yamano mizukiymn@yahoo.co.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 7

Yasuhiro Mochida yasuhiro.mochida@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 8

Machiko Oka m_oka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 9

Kyoko Maesato kyoko.maesato@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 10

Yusuke Tsukamoto y_tsukamoto2@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 11

Hidekazu Moriya hidekazu.moriya@tokushukai.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 12

Sumi Hidaka s_hidaka@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 13

Shuzo Kobayashi shuzo@shonankamakura.or.jp Shonan Kamakura General Hospital Kidney Disease and Transplant Center Kamakura Japan -

Co-author 14

Co-author 15

Introduction

Lesions of lower extremity arterial disease (LEAD) in dialysis patients are frequently found in the more distal parts of the lower extremities. Therefore, the therapeutic effect of revascularization of the major arteries of the lower extremities alone is limited. Even with the current advances in revascularization technology, the prognosis of dialysis patients who have developed comprehensive severe chronic limb-threatening ischemia (CLTI) remains unsatisfactory, even after revascularization treatment. To overcome CLTI in dialysis patients, a therapeutic strategy that improves peripheral microcirculatory impairment, in addition to revascularization treatment, is important. In this study, we evaluated the treatment outcomes　and efficacy in dialysis patients with CLTI who underwent a LDL apheresis treatment using the RheocanaⓇ, novel apheresis device and direct blood absorption therapy.

Methods

This single-center retrospective observational study analyzed 31 dialysis patients with CLTI (mean [±SD] age 67±11 years; dialysis history 106.9 ± 75.5 months; males, 74.2%; diabetes 80.6%) who underwent LDL apheresis with the Rheocarna.

Results

LDL apheresis therapy using the Rheocarna was performed median 7 sessions (IQR 4-12 sessions, range 1-20 sessions). Prior endovascular treatment (EVT) was performed in 6 cases above the knee, 25 cases below the knee, and 8 cases in the foot (overlapping cases), with below-knee vascular treatment accounting for approximately 80%. ABI values showed a significant improvement from 1.0 ± 0.17 before Rheocarna therapy to 1.07 ± 0.15 at 3 months post-Rheocarna therapy (p=0.041). No significant improvement was observed in SPP（pre-apheresis 46±21mmHg, post- 66±28mmHg, p=0.15）. Ulcer healing rate, major limb amputation rate, and mortality rate 6 months post-treatment were 25.8%, 35.5%, and 22.6%, respectively.

Conclusion

While Rheocanna therapy has resulted in wound healing the healing of intractable wounds in some dialysis patients with CLTI, many CLTI patients still have a great risk for lower limb amputation or death. We also evaluate and present the associating factors for wound healing in dialysis patients with CLTI.

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