{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:02:29Z","timestamp":1789624949167,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Lipoprotein apheresis is an adjunctive treatment for severe peripheral artery disease (PAD) and is a Category II indication for peripheral vascular diseases in the American Society for Apheresis guidelines. Rheocarna, a direct hemoperfusion adsorption device used in Japan for severe PAD and chronic limb\u2010threatening ischemia (CLTI), is designed to remove LDL cholesterol (LDL\u2010C) and fibrinogen (Fib). Device performance is often summarized by pre\u2212\/post\u2010treatment values or a single\u2010point extraction ratio (ER), which may not capture time\u2010dependent changes in adsorption efficiency. We therefore characterized serial ER profiles during Rheocarna treatment in maintenance hemodialysis patients with severe CLTI (5 patients, 10 sessions) and in a closed\u2010loop ex\u00a0vivo system using pooled plasma. Inlet and outlet samples were obtained serially, and ER was calculated as (\n                    <jats:italic>C<\/jats:italic>\n                    <jats:sub>in<\/jats:sub>\n                    \u2009\u2212\u2009\n                    <jats:italic>C<\/jats:italic>\n                    <jats:sub>out<\/jats:sub>\n                    )\/\n                    <jats:italic>C<\/jats:italic>\n                    <jats:sub>in<\/jats:sub>\n                    \u2009\u00d7\u2009100. In clinical sessions, median LDL\u2010C ER declined from 73.7% (IQR 70.9\u201376.2) at baseline to 12.3% (10.3\u201314.6) at 60\u2009min and 5.2% (3.1\u20138.2) at 120\u2009min (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Fib ER similarly declined from 63.3% (59.9\u201369.9) at baseline to 7.9% (6.2\u201310.1) at 60\u2009min and 6.5% (5.1\u20137.5) at 120\u2009min (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001). In the ex\u00a0vivo system, LDL\u2010C ER also decreased over time (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0274), whereas Fib ER showed a more variable pattern (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.1877). These findings show that extraction efficiency changes substantially during a treatment session and may not be fully captured by a single\u2010point ER. Serial ER profiling may provide a more detailed assessment of the time\u2010dependent performance of adsorption\u2010based apheresis devices.\n                  <\/jats:p>","DOI":"10.1002\/jca.70179","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:14:04Z","timestamp":1789622044000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time\u2010Dependent Decline in Extraction Ratios for\n                    <scp>LDL<\/scp>\n                    Cholesterol and Fibrinogen During a Single Rheocarna Treatment Session"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8393-9333","authenticated-orcid":false,"given":"Masayoshi","family":"Kukida","sequence":"first","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Itsuki","family":"Miyake","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayaka","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumikazu","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7376-1874","authenticated-orcid":false,"given":"Satoru","family":"Shichijo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Hirakawa","sequence":"additional","affiliation":[{"name":"Department of Clinical Support, ME Center Ehime University Hospital  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bunya","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Clinical Support, ME Center Ehime University Hospital  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Mima","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saiseikai Imabari Hospital  Imabari Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7461-369X","authenticated-orcid":false,"given":"Osamu","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology, Hypertension and Nephrology Ehime University Graduate School of Medicine  Toon Ehime Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"issue":"24","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"e1313","DOI":"10.1161\/CIR.0000000000001251","article-title":"ACC\/AHA\/AACVPR\/APMA\/ABC\/SCAI\/SVM\/SVN\/SVS\/SIR\/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"149","author":"Gornik H. L.","year":"2024","journal-title":"Circulation"},{"issue":"6","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"3S","DOI":"10.1016\/j.jvs.2019.02.016","article-title":"Global Vascular Guidelines on the Management of Chronic Limb\u2010Threatening Ischemia","volume":"69","author":"Conte M. S.","year":"2019","journal-title":"Journal of Vascular Surgery"},{"issue":"2","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/jca.22043","article-title":"Guidelines on the Use of Therapeutic Apheresis in Clinical Practice \u2010 Evidence\u2010Based Approach From the Writing Committee of the American Society for Apheresis: The Ninth Special Issue","volume":"38","author":"Connelly\u2010Smith L.","year":"2023","journal-title":"Journal of Clinical Apheresis"},{"issue":"1","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/0021-9150(87)90089-X","article-title":"A New Low Density Lipoprotein Apheresis System Using Two Dextran Sulfate Cellulose Columns in an Automated Column Regenerating Unit (LDL Continuous Apheresis)","volume":"68","author":"Mabuchi H.","year":"1987","journal-title":"Atherosclerosis"},{"issue":"10","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.5551\/jat.64639","article-title":"Lipoprotein Apheresis Alleviates Treatment\u2010Resistant Peripheral Artery Disease Despite the Normal Range of Atherogenic Lipoproteins: The LETS\u2010PAD Study","volume":"31","author":"Ueda E.","year":"2024","journal-title":"Journal of Atherosclerosis and Thrombosis"},{"issue":"1","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s10157-007-0003-8","article-title":"Applications of LDL\u2010Apheresis in Nephrology","volume":"12","author":"Kobayashi S.","year":"2008","journal-title":"Clinical and Experimental Nephrology"},{"issue":"2","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/1744-9987.13915","article-title":"A Novel Low\u2010Density Lipoprotein\/Fibrinogen Apheresis Method for Chronic Limb\u2010Threatening Ischemia in Patients With Poor Options for Revascularization: A Multicenter, Single\u2010Arm Clinical Trial","volume":"27","author":"Kobayashi S.","year":"2023","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"5","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1253\/circj.CJ-24-0830","article-title":"Efficacy of Rheocarna(), a Novel Apheresis Device, in Patients With no\u2010 or Poor\u2010Option Chronic Limb\u2010Threatening Ischemia","volume":"89","author":"Soga Y.","year":"2025","journal-title":"Circulation Journal"},{"issue":"6","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1111\/1744-9987.14050","article-title":"Evaluation of the Treatment Volume and Removal Rate of Rheocarna: A Novel Adsorption\u2010Type Blood Purification Device for Patients With Chronic Limb\u2010Threatening Ischemia","volume":"27","author":"Ohkubo A.","year":"2023","journal-title":"Therapeutic Apheresis and Dialysis"},{"key":"e_1_2_11_11_1","doi-asserted-by":"crossref","DOI":"10.1100\/2012\/314283","article-title":"LDL\u2010Apheresis: Technical and Clinical Aspects","volume":"2012","author":"Bambauer R.","year":"2012","journal-title":"Scientific World Journal"},{"issue":"6","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1111\/1744-9987.14049","article-title":"Short Term\u2010Efficacy and Tolerability of Rheocarna, a Novel Direct Hemoperfusion Adsorptive Column, for Chronic Limb\u2010Threatening Ischemia in Dialysis Patients: A Single\u2010Center Case Series","volume":"27","author":"Imai E.","year":"2023","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"8","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14082589","article-title":"The Effectiveness of Low\u2010Density Lipoprotein\/Fibrinogen Apheresis in Promoting Wound Healing of no\u2010Option Chronic Limb\u2010Threatening Ischemia Foot Ulcers With Wound, Ischemia, and Foot Infection (WIfI) Wound Grade 3: A Single\u2010Center Retrospective Analysis","volume":"14","author":"Fujii M.","year":"2025","journal-title":"Journal of Clinical Medicine"},{"issue":"10","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s00134-022-06810-1","article-title":"Hemoperfusion in the Intensive Care Unit","volume":"48","author":"Ricci Z.","year":"2022","journal-title":"Intensive Care Medicine"},{"issue":"1","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/s13054-018-2181-z","article-title":"Extracorporeal Techniques for the Treatment of Critically Ill Patients With Sepsis Beyond Conventional Blood Purification Therapy: The Promises and the Pitfalls","volume":"22","author":"Ankawi G.","year":"2018","journal-title":"Critical Care"},{"issue":"4","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/1744-9987.14117","article-title":"Investigation of Treatment Volume Versus Circulating Blood Volume During Rheocarna Treatment","volume":"28","author":"Hoshikawa Y.","year":"2024","journal-title":"Therapeutic Apheresis and Dialysis"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70179","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jca.70179","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.70179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:14:07Z","timestamp":1789622047000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.70179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/jca.70179"],"URL":"https:\/\/doi.org\/10.1002\/jca.70179","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"value":"0733-2459","type":"print"},{"value":"1098-1101","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"2026-05-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70179"}}