{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:51:58Z","timestamp":1791179518355,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T00:00:00Z","timestamp":1791072000000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K15951"],"award-info":[{"award-number":["25K15951"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"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>Chronic limb\u2010threatening ischemia (CLTI), a severe manifestation of peripheral artery disease, is particularly prevalent among patients receiving maintenance hemodialysis (HD) and is associated with poor limb and survival outcomes. Low\u2010density lipoprotein (LDL) apheresis, including Rheocarna, is used as adjunctive therapy for refractory CLTI; however, intraprocedural hypotension remains a major limitation, especially when combined with HD. We examined the effects of dialyzer membrane type and extracorporeal circuit sequence on hemodynamic stability during concomitant therapy. This case series comprised two patients with CLTI receiving maintenance HD. Each patient underwent four treatment sessions representing the four configurations defined by two dialyzer membranes (polysulfone [PS] and AN69) and two circuit sequences (Rheocarna \u2192 dialyzer vs. dialyzer \u2192 Rheocarna). Hemodynamic parameters, including systolic blood pressure, relative blood volume change (\u0394BV), and peripheral microvascular perfusion assessed by laser Doppler flowmetry (\u0394LDF), were assessed during each treatment session. In both cases, the Rheocarna \u2192 AN69 configuration showed the smallest early decrease in systolic blood pressure and the most favorable early \u0394BV pattern among the four sessions. Toe \u0394LDF was preserved or increased with this configuration. The other three configurations were associated with larger early decreases in systolic blood pressure in one or both patients, including a decrease to below 90\u2009mmHg in Case B. These findings suggest that dialyzer membrane type and circuit sequence may influence intraprocedural hemodynamic stability during concomitant Rheocarna therapy and HD. Among the tested configurations, Rheocarna \u2192 AN69 showed better hemodynamic tolerance and preservation of peripheral perfusion. These hypothesis\u2010generating findings warrant further evaluation in larger prospective studies.<\/jats:p>","DOI":"10.1002\/jca.70184","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T05:04:01Z","timestamp":1791176641000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraprocedural Hemodynamics During Concomitant Rheocarna Therapy and Maintenance Hemodialysis: Effects of Dialyzer Membrane Type and Circuit Sequence"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5407-3985","authenticated-orcid":false,"given":"Yusuke","family":"Ishizuka","sequence":"first","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genshin","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shizuka","family":"Ishigaki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Enoki","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kako","family":"Kajiwara","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiko","family":"Nakasato","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sosuke","family":"Kinomura","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saori","family":"Kin","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Noguchi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Yoshizawa","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Kikuchi","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiaki","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koki","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Hemodialysis Unit Minamisanriku Hospital  Minamisanriku Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuhiro","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7601-6557","authenticated-orcid":false,"given":"Koji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Graduate School of Medicine Tohoku University  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,4]]},"reference":[{"issue":"6","key":"e_1_2_13_2_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. 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A.","year":"2011","journal-title":"Kidney International"},{"issue":"3","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"265","DOI":"10.5551\/jat.65843","article-title":"Chronic Limb\u2010Threatening Ischemia in Patients Undergoing Hemodialysis: Epidemiology, Risk Factors, and Outcomes","volume":"33","author":"Komaba C.","year":"2026","journal-title":"Journal of Atherosclerosis and Thrombosis"},{"issue":"3","key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1177\/17085381221076943","article-title":"Association of Wound, Ischemia, and Foot Infection Clinical Stage With Frailty and Malnutrition in Chronic Limb\u2010Threatening Ischemia Patients Undergoing Endovascular Intervention","volume":"31","author":"Otsuji H.","year":"2023","journal-title":"Vascular"},{"issue":"8","key":"e_1_2_13_10_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":"1","key":"e_1_2_13_11_1","first-page":"11","article-title":"Dextran Sulfate Adsorption of LDL (DSAL) and Rheocarna in LDL Apheresis for Chronic Limb\u2010Threatening Ischemia (CTLI)","volume":"44","author":"Mochida Y.","year":"2025","journal-title":"Japanese Journal of Apheresis"},{"issue":"5","key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1253\/circj.CJ-24-0830","article-title":"Efficacy of Rheocarna((R)), 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":"3","key":"e_1_2_13_13_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/1744-9987.14105","article-title":"Correlation Between Bradykinin Concentration and Blood Pressure During Rheocarna Therapy: A Single\u2010Center Case Series","volume":"28","author":"Handa T.","year":"2024","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"6","key":"e_1_2_13_14_1","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1111\/1744-9987.70067","article-title":"Transcutaneous Oxygen Tension and Bradykinin Concentration During Rheocarna Therapy: Case Series","volume":"29","author":"Handa T.","year":"2025","journal-title":"Therapeutic Apheresis and Dialysis"},{"issue":"1","key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1186\/s12882-019-1662-x","article-title":"Intradialytic Hypotension Is an Important Risk Factor for Critical Limb Ischemia in Patients on Hemodialysis","volume":"20","author":"Matsuura R.","year":"2019","journal-title":"BMC Nephrology"},{"issue":"6","key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1093\/ckj\/sfaa078","article-title":"An Update Review of Intradialytic Hypotension: Concept, Risk Factors, Clinical Implications and Management","volume":"13","author":"Kanbay M.","year":"2020","journal-title":"Clinical Kidney Journal"},{"issue":"6","key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1016\/j.kint.2021.01.018","article-title":"The Time of Onset of Intradialytic Hypotension During a Hemodialysis Session Associates With Clinical Parameters and Mortality","volume":"99","author":"Keane D. 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