Hemodialysis Machine Research Articles

A Proof-of-Principle Study of the Design and Optimization of a Novel Fluid-Driven Automated Retracting Needle System

Abstract The cannulation of blood vessels is one of the most basic and essential interventions in medical practice. A common adverse event of this procedure is miscannulation with infiltration of the second part of the vessel wall, often resulting in a perivascular hematoma. In hemodialysis patients, surgically created arteriovenous conduits are cannulated 3–4 times per week to provide sufficient blood supply to the hemodialysis machine. However, the high blood flow and pressure in these vascular access sites increase the risk of complications upon miscannulation. A novel needle system that allows for rapid automatic retraction of the needle in response to contact with blood after positioning the cannula in the blood vessel was developed to reduce the risk of miscannulation. The device can easily be incorporated into existing needle designs. The mechanical functionality of the device was validated by testing prototypes in an ex vivo system. Optimization of the needle system was performed to enhance response time and piston shape. A final prototype design was manufactured and validated. The optimal membrane composition and piston shape were determined, which resulted in a needle response time of 40 ms upon contact with fluid at a pressure of 100 mmHg (arterial pressure). Here, we have successfully designed, mechanically validated, and tested a novel automated rapid needle retraction system that allows incorporation into existing needle systems. This device could notably decrease the difficulty of vessel cannulation and the prevalence of hematoma formation.

An experimental study on real–time analysis of two–phase peristaltic slug flows in dialysis machines

Two–phase flows appear in many industrial and biomedical applications. One of the most vital biomedical applications of two–phase flows is in hemodialysis machines due to air embolism and heparin injection. Since these flows have a very complex and intermittent nature, studying their dynamics is a very challenging and fundamental problem. The purpose of this article is to present an experimental study on the dynamics of two–phase peristaltic slug flows. The measurement strategy is based on the image processing technology. The characteristic parameters of the two–phase pulsatile slug flows, including the slug length, as well as the translational velocity and frequency of the slug motion, are measured, and the effect of the liquid flow rate and liquid superficial velocity is investigated. The results show that the average and maximum slug velocities, and also the dominant amplitude of the slug velocity increase with the flow rate and liquid superficial velocity, while it is not possible to clearly predict a correlation between the liquid superficial velocity and the slug length. The measurement strategy presented in this article can be used in the control and alarm systems of smart dialysis machines.

POS-662 5-YEAR SURVIVAL RATE OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS IN END-STAGE RENAL DISEASE IN INDONESIA: CAN CAPD BE SOLUTION FOR ESRD IN LOW INCOME DEVELOPING COUNTRY?

There are an increase in End-Stage Renal Disease (ESRD) patients in developing countries every year, including Indonesia. Based on the 2018 Indonesian Basic Health Research, 3.8 ‰ of the Indonesian population is ESRD patient. The number of available hemodialysis machines and hemodialysis nurses in Indonesia is far from optimal, and the number of procedures and success rate of kidney transplants is still very low. Considering those limitations, Continuous Ambulatory Peritoneal Dialysis (CAPD) therapy is chosen as an option for renal replacement therapy in Indonesia. This study is aimed to report the 5-year survival of ESRD patients undergoing CAPD therapy in low income developing countries such as Indonesia. A retrospective cohort study was conducted involving 674 ESRD patients undergoing CAPD therapy. Data was taken from medical records from Malang CAPD Center of Saiful Anwar Hospital from August 2014 to July 2020. The 5-year survival rate and hazard ratio were analyzed using Kaplan-Meier and cox-regression analysis, respectively. 674 ESRD patients undergoing CAPD, 63.2% of patients survived up to 5 years with a general survival rate at 1, 3, and 5 years of 80%, 60%, and 52%, respectively. The 3-year survival rate of CAPD therapy in ESRD patients with comorbid hypertension and type II diabetes mellitus was 80% and 10%, respectively. The hazard ratio of ESRD patients on CAPD therapy with comorbid type II diabetes mellitus was 8.4 times (95% CI = 6.36-11.21). The 5-year survival rate of ESRD patients with CAPD therapy in Indonesia was good. Patients with comorbid type II diabetes mellitus had a worse survival rate. With all the problems of hemodialysis and kidney transplantation that exist in low income developing countries, CAPD can be a solution for renal replacement therapy.

POS-537 COVID-19 IN PATIENTS ON MAINTENANCE HEMODIALYSIS - A SINGLE CENTER EXPERIENCE

The current coronavirus disease (COVID-19) pandemic has caused high morbidity and mortality in chronic kidney disease stage 5 (CKD-5) patients on maintenance hemodialysis (MHD). The unique problems faced by the hemodialysis (HD) units are frequent hospital visits by patients for MHD, waiting area for dependent population due to difficulty in maintaining social distancing. Here, we present our experience on the impact of COVID-19 pandemic on patients at our maintenance HD unit in South India. It is a retrospective study done over a period of seven months from April 2020 to October 2020 at a tertiary care institute in Hyderabad, India. We included 110 MHD patients and 45 HD staff in the study. We followed Initial screening of all the subjects with non-contrast computerised tomography (CT) chest followed by confirmation using real-time reverse transcription-polymerase chain reaction (rRT-PCR) for diagnosing COVID-19 infection. All the positive patients were dialysed in a separate isolation unit with separate HD machines and staff. Our unit strictly followed all the precautions and preventive measures for patients and staff according to the Government of India, Ministry of Health and Family Welfare Guidelines for dialysis in COVID-19 patients. Before each MHD session, patients were screened for symptoms telephonically before physical presence at the unit, and no attendants or maximum of one attendant was allowed. In the COVID-19 isolation MHD unit, strict protocols were followed. In the non-COVID-19 MHD unit, few cost-effective measures were followed, as shown in figure 1. 53 out of 110 (48%) MHD patients are tested positive for COVID-19 infection during the study period. The mean age of infected patients was 56.8 years, and 48 (90.5%) of them were males. The comorbidities and vascular access of the MHD patients did not affect the infectivity rate at our unit. The clinical presentation of most of the infected patients was asymptomatic (29, 54.7%) followed by fever (21, 39.6%). The recovery rate from infection is 81% (43 out of 53). Mortality was seen in 6 (11%) infected patients and 4 (7%) lost follow-up by shifting to other MHD units due to travel constraints during the lockdown period. The baseline and clinical characteristics of the patients are given in table 1 and 2.In a study by Ibernon et al from Spain, the incidence rate of COVID-19 in their HD unit was 9.5% to 19.9% and the death rate of 25 to 30.5%. (2) In the study by Corbett et al from the United Kingdom, the COVID-19 incidence rate at their HD unit was 19.2%. (3) In our study, the incidence of COVID-19 infection was quite high (48%), but the mortality rate was low (11%). 6 out of 45 (13%) staff members are tested positive for COVID-19. All of them recovered without any complications. The low infectivity rate among our staff members was probably due to strict and cost-effective protocols followed for prevention in the COVID isolation and non-isolation MHD units. The incidence of COVID-19 infection was 48% in our MHD unit. The mean age of the infected subjects was 56.8 years and most of them were males. Comorbidities and vascular access did not affect the infectivity rate at our patients. Most of the infected patients are asymptomatic. The positivity rate in our dialysis staff is 13% which is quite low probably due to the strict and cost-effective preventive measures at our MHD unit.

Evaluation of Physicochemical and Microbial Quality Control of Hemodialysis Machines Water in Hospitals

Abstract Background and Objectives: Water quality is important for preparation of dialysis solution due to its direct relationship with blood of patients with renal failure. The aim of this study was to evaluate the chemical and microbial quality of inlet and outlet water of dialysis devices in hospitals of East Azerbaijan province. Material and Methods: This study was a descriptive-analytical study in which the water of dialysis ward of three hospitals affiliated to East Azerbaijan University of Medical Sciences was investigated. The results of physicochemical (45 cases) and microbial (163 cases) of dialysis water were extracted from the relevant archives in two stages before and after reverse osmosis treatment during 2014-2016. Independent t-test and one-way ANOVA were used for statistical analysis while extracting descriptive statistical parameters. Data analysis was done using Excel and SPSS 23 software. Results: Evaluation of the efficiency of reverse osmosis system showed that there was a significant difference between water quality, before and after the system. Except for calcium, magnesium, fluoride and nitrate, the concentrations of other cations and anions in 100% of samples were lower than the European Pharmacopoeia standard. Incoming water samples to dialysis machine in 4.9% of cases had total coliform contamination and there was no fecal coliform in any of the samples. The frequency and frequency of tests in hospitals are not observed and despite the risk of heavy metals, heavy metals tests are not performed on dialysis water for the health of dialysis patients. Conclusion: The need to develop a national standard for controlling dialysis water, testing all quality parameters of dialysis water according to standards in regular times and timeframes, informing hospital managers and environmental health experts about the importance of dialysis water quality in health and increasing life expectancy of dialysis patients is felt.

The Production, Efficacy, and Safety of Machine-Generated Bicarbonate Solution for Continuous Venovenous Hemodialysis (CVVHD): The Cleveland Clinic Method

Rationale & ObjectiveSince 1994, the Nephrology and Hypertension Department at the Cleveland Clinic has prepared and used bicarbonate-based solution for continuous venovenous hemodialysis (CVVHD) using a standard volumetric hemodialysis machine rather than purchasing from a commercial vendor. This report describes the process of producing Cleveland Clinic UltraPure Solution (CCUPS), quality and safety monitoring, economic costs, and clinical outcomes.Study DesignRetrospective study.Setting & ParticipantsCVVHD experience at Cleveland Clinic, focusing on dialysate production, institutional factors, and patients requiring continuous kidney replacement therapy. Production is shown at www.youtube.com/watch?v=WGQgephMEwA.OutcomesFeasibility, safety , and cost.ResultsOf 6,426 patients treated between 2011 and 2019 with continuous kidney replacement therapy, 59% were men, 71% were White, 40% had diabetes mellitus, and 74% presented with acute kidney injury. 98% of patients were treated with CVVHD using CCUPS, while the remaining 2% were treated with either continuous venovenous hemofiltration or continuous venovenous hemodiafiltration using commercial solution. The prescribed and delivered effluent doses were 24.8 (IQR) versus 20.7 mL/kg/h (IQR), respectively. CCUPS was as effective in restoring electrolyte and serum bicarbonate levels and reducing phosphate, creatinine, and serum urea nitrogen levels as compared with packaged commercial solution over a 3-day period following initiation of dialysis, with a comparable effluent dose. Among those with acute kidney injury, mortality was similar to that predicted with the 60-day acute kidney injury predicted mortality score (r = 0.997; CI: 0.989-0.999). At our institution, the cost of production for 1 L of CCUPS is $0.67, which is considerably less than the cost of commercially purchased fluid.LimitationsObservational design without a rigorous control group.ConclusionsCVVHD using locally generated dialysate is safe and cost-effective.

The Effect of Preparing Dialysis Machine Using Normal Saline-Heparin on the Dialysis Adequacy of Hemodialysis Patients: A Crossover, Two-Group, and Randomized Clinical Trial

Background: Patients with end-stage renal disease (ESRD) need adequate dialysis. Thus, identification of the ways to enhance dialysis adequacy is very important. Objectives: The present study was conducted to examine the effect of preparing a dialysis machine using a normal saline heparin method on the dialysis adequacy of hemodialysis patients. Methods: This study was conducted in Hamadan in 2019. A total of 36 patients with hemodialysis were selected using convenience sampling who were assigned to the control and intervention groups. The hemodialysis machine was primed for one month using a routine method (control) and one month using a normal saline-heparin method (intervention). Urea reduction ratio (URR) and Kt/V indices were calculated at the beginning and end of each month in the intervention and control groups. Data were analyzed using paired and independent t-test. Results: In the normal saline-heparin group, KT/V showed a statistically significant difference before and after the treatment (P = 0.013), as well as an increase in the KT/V. The URR as the mean dialysis adequacy showed a statistically significant difference (P = 0.004) between the normal saline group and the normal saline-heparin group before and after the treatment. Moreover, URR in the normal saline-heparin group increased after the treatment. In the normal saline treatment group, KT/V and URR decreased after the treatment. In the normal saline group, URR decreased after the treatment. Conclusions: Applying the hemodialysis machine preparation with a normal saline-heparin method increased dialysis adequacy in the patients who underwent hemodialysis.

Prescribing Home Hemodialysis.

Home hemodialysis (HHD), performed more frequently than in-center hemodialysis, is underutilized in the United States but has had a recent resurgence driven predominantly by innovative dialysis equipment that is easy to use, less intrusive to the home, and requires less storage space. There are 3 different hemodialysis machines approved for use in the home but currently NxStage™ accounts for the overwhelming majority of HHD patients. Therefore, it is the focus of this article. To minimize storage space in the home, the NxStage platform minimizes the volume of dialysate that is used per treatment. We refer to this method as the Frequent Low Dialysate Volume Approach (FLDVA). The approach to urea removal with the NxStage platform is much different compared to traditional in-center HD. To minimize the volume of dialysate per treatment, and still achieve target urea removal, the dialysate must be highly saturated. In this article, we explain how to increase the saturation of dialysate fluid. We also draw a parallel between urea removal in peritoneal dialysis and NxStage therapy and use that model to estimate an initial HHD prescription and to alter prescriptions when necessary.

Psychological Stressors among Hemodialysis Patients in Selected County Dialysis Centre's in Kenya

Introduction: Though hemodialysis treatment modality remains the most sought option among patients with kidney disease, the modality is associated with multiple psychological stressors that confronts the hemodialysing patients and subject them to mental disturbances and poor quality of life. Study aim: The study aimed at describing the psychological stressors faced by the hemodialysis patients in the new county dialysis centers in Kenya and to correlate the psychological stressors to the patients’ demographic characteristics. Methodology: This was a descriptive correlation study among hemodialysis patients in four selected county dialysis centers in Kenya. Sample size was determined through a census method. Data was collected by means of a semi-structured questionnaire and analyzed using a Statistical Package for Social Sciences (SPSS) version 25.0.Findings were presented using graphs and frequency tables while Chi-square was used to test for the association between study variables. Results: Despite opening new county dialysis centers, majority of the respondents identified inadequate number of hemodialysis machines as the major psychological stressor (M=2.9, SD ± 0.8) uncertainty in life (M=2.74, SD ± 0.6) and lack of hemodialysis commodities (M=2.69, SD=0.7) as the leading psychological challenges faced by the patients who are dialyzing in the newly opened county dialysis centres in Kenya. There was a statistically significant association (p=0.016) between waiting time for hemodialysis sessions and gender and also a significant association (p=0.04) between marital status and dependency on others to bring them for dialysis session. Conclusion: Despite the Government initiative to increase the availability and accessibility of the hemodialysis services to hemodialysis patients, inadequate hemodialysis machines, lack of hemodialysis commodities and difficulties in raising the cost of treatment still remains the major psychological stressors among hemodialysis patients. Therefore, opening of new dialysis centers should be accompanied with adequate resource allocation to guarantee positive patient outcomes.

A multi-center outbreak of Candida tropicalis bloodstream infections associated with contaminated hemodialysis machine prime buckets

Outbreaks of fungal bloodstream infection (BSI) are uncommon among hemodialysis patients. We investigated an outbreak of Candida tropicalis BSIs involving patients at 3 of 4 affiliated hemodialysis units. An investigation included a review of records of patients with C tropicalis BSI, a case-control study, and cultures of medications, hands of personnel, dialysis equipment, and water samples. Eight patients developed C tropicalis BSIs in a 3-month period. Compared to controls, cases had a higher proportion of preceding dialyses performed on a machine with a contaminated saline prime bucket (SPB) (P= .02). Observations revealed that SPBs at units A-C were rinsed with tap water, were not routinely disinfected, and that priming tubing was allowed to contact fluid in SPBs. C tropicalis was recovered from the main compartment and hollow handle of SPBs and from other environmental samples. C tropicalis isolates from patients, SPBs and other environmental samples had indistinguishable pulsed-field gel electrophoresis patterns. Following routine disinfection of SPBs, the outbreak terminated. This outbreak was likely due to inadequate disinfection of SPBs. The findings emphasize the importance of disinfection of SPBs. Current use of identical SPBs warrants further evaluation of hollow SPB handles as a potential infection risk.

The development of Hemodialysis Units in the Army Hospital

Patients with renal disease require special care.This study aims to develop a hemodialysis unit in the Army Hospital that require the act of washing the blood as a form to improve health services for patients with kidney failure. In this study, the majority of patients covered by the National Health insurance. Research methods namely method a case study with quantitative descriptive analysis.The results of this study show that the development of the hemodialysis unit will give a positive impact for the patient and for the hospital. The review will be the addition of hemodialysis machines, the addition of a new building, the addition of shift nurse can be seen that all these options will be profitable in the foreseeable future. This of course can make the best judgment for the Hospital in determining a decision for the sake of improving health care for the patient.

Hemodialysis Minimal is the Future

Father of Hemodialysis, Willelm Kolff a Dutch physician, during the terrible times of Nazi occupation risked his life to experiment and invent the first hemodialysis machine. One can imagine, that the power to do something good for your fellow human beings does not wait for the perfect times and facilities.

Influence of hemodialysis blood flow rate on the thrombogenic potential in patients with central venous catheters.

In this study we apply methods to determine the tendency for thrombus formation in different central venous catheters (CVC) models associated with flow rate variation. To calculate the thrombogenic potential, we proposed a new numerical model of the platelet lysis index (PLI) equation. To compare the results of PLI and flow rate in different models of catheters, numerical calculations were performed on three different tips of CVC. The results showed that the PLI increases as a power function of the flow rate independent of the type of CVC. This study evidenced that the higher the blood flow rate used in the catheter, the greater the potential for thrombus formation. The PLI computed at the catheter outlet presented higher values when compared to the values computed at the vein outlet indicating that the blood flow through the CVC arterial lumen presents a proportionally larger thrombogenic potential when compared to the blood flow that leaves the vein towards the atrium. This finding may have consequences for clinical practice, since there is no specific flow value recommended in the catheter when the hemodialysis machine is turned on, and with this equation it was possible to demonstrate the thrombogenic potential that the flow rate can possibly offer.

Occupational Blood Exposure of Nursing Staff During Dialysis Connection and Disconnection Procedures: A Quantitative Assessment

Background: Hemodialysis patients are at high risk for developing healthcare-associated infections and acquiring multidrug-resistant microorganisms. The importance of hand hygiene in the prevention of healthcare-associated infections is well known. To date, no quantitative study has been undertaken to verify hand hygiene and nosocomial infection management prevention and control. Methods: This quantitative, exploratory, descriptive, observational study used the pyramidon semi-quantitative examination method to detect hemoglobin on the fingers of enrolled nursing staff. We sampled all the fingers of participants who had just finished operating vascular access routes during randomly selected 15-min detection periods that covered all steps of a hemodialysis session (connection and disconnection). Findings: In all the periods that were investigated, numerous residual blood-exposure positive results were found on the fingers of the nurses. Among a total of 454 samples, 273 were found to be residual blood positive and 181 were negative on semi-quantitative examination. The processes where significant differences were found included connection and disconnection of the vascular access routes to the hemodialysis machine (p<0.001). Interpretation: The novel detection method provides direct evidence for hand-based exposure to blood by hemodialysis nurses during the operation of the patient’s vascular access route for hemodialysis. Pyramidon semi-quantitative examination is an excellent method for the evaluation of blood exposure in a hemodialysis unit. Enhanced hand hygiene can be achieved through immediate and intuitive feedback. Clinical Trial Registration Details: This study has been registered with the China Clinical Trial Center, and the number is: ChiCTR2100051448. Funding Information: This study did not receive any funding or financial support. Declaration of Interests: All other authors do not declare any conflict of interest related to the results of this study. Ethics Approval Statement: This research project was approved by the ethical review board of the Affiliated Hospital of Inner Mongolia Medical University (No. KY2020027).

Psychological assessment in children with chronic kidney disease on regular hemodialysis

Introduction: Interestingly, health care professionals have the tendency to focus on the biological dimension of the disease or other technical issues related to hemodialysis machine and usually underestimate symptoms from mental sphere. Encouraging patients to express their feelings and addressing their psychological needs may be an essential measure to confront with this debilitating disease. Aim of Study: The objective of our study were to assess the presence, possible factors related and consequences of psychological disorders in children with CKD on regular hemodialysis. Methods: This study was cross sectional study which carried out in nephrology unit of the pediatric department during the period from February 2019 to December 2019.It were comprised (141) children with CKD on regular hemodialysis of both sexes after obtaining informed consent from children's parents. All patients were subjected to history (age, sex, residence, birth order, level of education, socioeconomic status), examination and specific investigations. Results: This study showed that, a male predominance. Regarding anxiety grade, mild were 18 (12.8%), moderate were 54 (38.3%) and severe were 69 (48.9%). Regarding depression grade, mild were 50 (35.5%), moderate were 54 (38.3%), and severe were 19 (13.5%) while no depression was found among 18 (12.8%).There were statistically significant positive correlations between anxiety score and duration of dialysis. There were statistically significant positive correlations between anxiety score and depression score. Conclusion: Frequency of anxiety and depression is high in CKD Patients. There were statistically significant positive correlations between anxiety score and depression score.

In-House Production of Dialysis Solutions to Overcome Challenges During the Coronavirus Disease 2019 Pandemic

In-House Production of Dialysis Solutions to Overcome Challenges During the Coronavirus Disease 2019 Pandemic

Analisis Biaya dan Manfaat Berbagai Skema untuk Pelayanan Hemodialisis di Rumah Sakit DR. Sitanala Tangerang

This research was conducted to review the clinical pathway and the calculation of total cost of hemodialysis services and to see the comparison of cost and benefits of hemodialysis services with the Operational Cooperation system and self-management in RSK DR Sitanala Tangerang in 2017 from 3 (three) Hemodialysis Machine Providers. The total cost of hemodialysis services with the Operational Cooperation system and self-management is the result of direct and indirect cost calculation with a combination of Activity Based Costing (ABC) methods in accordance with outpatient clinical pathways. Total Cost is obtained by summing the multiplication results between each activity cost in the period of 18 months. Revenue is obtained by summing the multiplication of hospital rates to the number of actions or visits of patients in 18 months. The result of the analysis of the benefits of hemodialysis costs turns out that the Operational Cooperation system is more profitable than self-managed.

Hemodialysis With the Quanta SC+: Efficacy and Safety of a Self-care Hemodialysis Machine

Rationale & ObjectiveMost patients with kidney failure receive hemodialysis 3 times per week in a facility. More frequent and longer duration dialysis prescriptions improve a number of key outcome measures. These prescriptions are best suited to self-care and home regimens. The Quanta SC+ hemodialysis system is a novel device with demonstrated ease of use for patients and health care practitioners through human factors testing. The primary objective of this study is to report the efficacy and safety of the SC+ system using conventional hemodialysis prescriptions.Study DesignNonrandomized observational study.Setting & ParticipantsPrevalent hemodialysis patients in 4 sites in the United Kingdom were recruited to switch from their current device to the SC+ system with no other changes to their prescription.InterventionsSC+ hemodialysis system.OutcomesEfficacy data were collected in terms of dialysis adequacy, urea reduction ratios, and net fluid removal accuracy.Results60 patients were enrolled in the study, resulting in 1,333 evaluable treatments. The threshold single-pool Kt/V of 1.2 was exceeded in 96.6% of treatments in patients receiving 3-times-weekly regimens, whereas the threshold standard Kt/V of 2.1 was exceeded in 94% of treatments and 97.6% of treatments in patients without significant residual kidney function. Ultrafiltration accuracy was determined by measuring net fluid removal and validated to be within acceptable limits. The adverse event profile during treatment was typical of hemodialysis. There were no serious adverse events.LimitationsFew patients on high-frequency treatment regimens were enrolled.ConclusionsThe SC+ system delivers safe and effective hemodialysis across a range of patients and dialysis prescriptions. It is one of the smallest systems available and has validated usability for patients to perform self-care safely with minimal training. This device may encourage patients to feel empowered to take on home hemodialysis, unlocking beneficial clinical and patient-reported outcomes associated with these modalities.

Sustained Low-Efficiency Dialysis with Regional Citrate Anticoagulation and a Standard Hemodialysis Machine in Critically Ill Patients with AKI

Sustained Low-Efficiency Dialysis with Regional Citrate Anticoagulation and a Standard Hemodialysis Machine in Critically Ill Patients with AKI

Therapeutic plasma exchange with standard hemodialysis machine as an alternative to dedicated apheresis device: A 5-year experience.

Patients suffering from various diseases have been shown to benefit from therapeutic plasma exchange (TPE). However, in developing countries, there are many obstacles hindering the establishment and initiation of TPE programs. These include inadequate funding and lack of government healthcare coverage. Our center in Thailand practices a unique membrane plasma separator technique using a hemodialysis machine incorporated with a plasma separator. Over a 5 year period, there were 130 such sessions conducted in 24 patients. The indications for TPE treatment included neurological, hematological, and nephrological diseases. Overall, response to TPE was good. Some TPE-related adverse events did occur, but none were life-threatening. Unfortunately, infection remained a problem and was sometimes a cause of death. Future challenges include minimization of infection rates and making TPE treatment readily accessible to patients.