Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients
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ORIGINAL ARTICLE
Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients Naile Tufan Pekkucuksen 1,2
&
Katie E. Sigler 2 & Ayse Akcan Arikan 2,3 & Poyyapakkam Srivaths 2
Received: 9 September 2019 / Revised: 15 April 2020 / Accepted: 27 April 2020 # IPNA 2020
Abstract Background The objectives of the study are to describe tandem therapeutic plasma exchange (TPE) and continuous kidney replacement therapy (CKRT) patients’ outcomes in a large institution. Methods We reviewed pediatric patients receiving tandem TPE and CKRT from 2013 to 2016. Over the study period, 63 discrete patients received tandem TPE and CKRT for a total of 378 TPE procedures on 1676 days on CKRT. Results Patient age ranged from newborn to 19 years old with weights ranging from 2.31 to 112.3 kg (17 patients were < 10 kg and less than 1 year old). All procedures were completed in intensive care units (ICU) as CKRT can only be done in this environment. All treatments completed successfully; majority of patients (90%) developed hypocalcemia though none were symptomatic. Case mortality rate was 40%. Disease severity scores at ICU admission were higher and time to TPE and CKRT start was longer in the deceased group. Conclusions As a conclusion, though complications including hypocalcemia are common with tandem TPE and CKRT in pediatrics, patients remained asymptomatic. Such treatments have to be carefully planned with interdisciplinary teams to address indications, technicalities, and complications. Keywords Tandem . Plasmaphresis . Plasma exchange . CKRT . Pediatrics . PICU
Introduction Plasmapheresis (PP) is a blood purification procedure, based on the extracorporeal separation of blood cellular components from colloid plasma and return of the cells to the patient circulatory system combined with a replacement solution of either 5% albumin or donor fresh frozen plasma (FFP). It has been used successfully to reduce the concentration of large molecules such as pathogenic antibodies, immune complexes, cryoglobulins, and lipoproteins [1]. Therapeutic plasma exchange (TPE) indications are categorized by the American Society for Apheresis (ASFA) [2]. Continuous kidney replacement therapy (CKRT) is the treatment modality for acute kidney injury (AKI), fluid * Naile Tufan Pekkucuksen [email protected] 1
Department of Pediatrics, Pediatric Nephrology Division, University of Florida, Gainesville, FL, USA
2
Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, USA
3
Department of Pediatrics, Section of Critical Care Medicine Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
overload (FO), and electrolyte and metabolic imbalance for unstable patients. In some situations, patients need multiple modalities of extracorporeal support. Simultaneous use of multiple modalities with dedicated machines combined in series or in parallel is defined as tandem therapies (Fig. 1). Patients who have received tandem TPE with intermittent hemodialysis (HD) in both adults and children
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