Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Betti, Silvia; Újszászi, Ákos; Schaefer, Susanne; Heckert, Karl Heinz; Schaefer, Franz; Schmitt, Claus Peter

doi:10.2215/cjn.12581213

Cited by 21 publications

(17 citation statements)

References 13 publications

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“…While prospective pediatric data is lacking, 26% of 249 adult patients enrolled in the prospective Oklahoma HUS/TTP registry over 12 years suffered major complications, of whom 2.8% died . Table describes studies reporting AE encountered during PEX in children . Similar to the present study, European multicenter registries of pediatric PEX, describing ~1100 sessions in more than 140 patients, report complications in 6% to 10% cases, chiefly comprising mild AE .…”

Section: Discussionsupporting

confidence: 67%

Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

Khandelwal

Thomas

Rathi

et al. 2019

J of Clinical Apheresis

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Background: While complement blockade with eculizumab is recommended as first-line therapy of atypical hemolytic uremic syndrome (aHUS), plasma exchanges (PEX) remain the chief option for anti-factor H (FH) antibody associated disease and when access to eculizumab is limited. Methods: We reviewed adverse events (AEs) and adverse outcomes (eGFR <30 mL/min/1.73 m 2 or death), in all patients with aHUS managed with membranefiltration based PEX at one tertiary care center over 5.5 years. Results: During January 2013 to June 2018, 109 patients with aHUS (74 with antibodies to FH), aged median (range) 7.6 (0.5-18) year weighing 22.1 (6-90) kg, underwent 2024 sessions of PEX. AE, in 12.1% patients, were usually self-limiting and included chills (5.5%), vomiting/abdominal pain (3.3%), hypotension (1.6%), urticaria (1.5%), seizures (0.2%), hypocalcemia (0.2%), and hemorrhage (0.1%); plasma hypersensitivity and severe reactions were rare. Rate of catheter-related infections was 1.45/1000 catheter-days. Filter reuse (OR 1.69; 95% CI 1.26-2.26; P < .001) and >20 sessions of PEX/patient (OR 1.99; 95% CI 1.27-3.10; P = .002) were independently associated with adverse events; infusion of IV calcium gluconate during PEX was protective (OR 0.26; 95% CI 0.16-0.43; P < .001). Hematological remission was achieved in 96.3% patients after 6 (5-8) PEX sessions; 80.8% and 89.6% patients were dialysis independent by one and 3 months, respectively. Conclusions: PEX is safe and associated with satisfactory short-term outcomes in children with aHUS. Prolonged PEX and filter-reuse are associated with complications.

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Section: Discussionsupporting

confidence: 67%

Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

Khandelwal

Thomas

Rathi

et al. 2019

J of Clinical Apheresis

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“…To minimize extracorporeal circulation, a volume-adapted pediatric MARS system (MARSmini) has been developed for use in children [14,15]. Different approaches use a combination of plasmapheresis and hemodialysis, performed simultaneously with a plasma separator and a high-flux filter configured serially in children with ALF [15,16].…”

Section: Discussionmentioning

confidence: 99%

Single-Pass Albumin Dialysis in the Treatment of Children with Liver Failure

Holle¹,

Gratopp²,

Balmer³

et al. 2019

Blood Purif

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Background and Aims: Acute and acute on chronic liver failure are life-threatening conditions, and bridging to transplantation is complicated by a paucity of suitable organs for children. While different modalities of extracorporeal liver support exist, their use in children is complicated by a large extracorporeal volume, and data on their use in children is limited. The aim of this analysis was to investigate the efficacy and safety of single-pass albumin dialysis (SPAD) in children with liver failure. Methods: Retrospective medical chart review of pediatric patients with liver failure treated with SPAD. The decrease in hepatic encephalopathy (HE) and the serum levels of bilirubin and ammonia were measured to determine efficacy. Adverse events were documented to assess safety. Results: Nineteen pediatric patients with a median age of 25.5 months and a median body weight of 11.9 kg were treated with SPAD between January 2011 and March 2018. Total bilirubin (p < 0.001) and ammonia (p = 0.02) significantly decreased after treatment with SPAD. As clinical outcome parameter, HE significantly improved (p = 0.001). Twelve patients were bridged successfully to liver transplantation. In all patients, 71 SPAD sessions were run. Clotting in the dialysis circuit was observed in 49% of all sessions. Heparin and citrate were used for anticoagulation and were significantly superior to dialysis without any anticoagulation (p= 0.03). Transfusion of packed blood cells (57%) and catecholamine therapy (49%) were frequently necessary. Conclusions: Treatment with SPAD was effective in detoxification, as measured by significant improvement of HE and clearance from surrogate laboratory parameters.

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“…Unfractioned heparin is still the most widely used anticoagulant in membrane PE and HD . However, it has some limitations, the most important being a high risk of bleeding and heparin induced thrombocytopenia (HIT).…”

Section: Discussionmentioning

confidence: 99%

Citrate Anticoagulation in Tandem Membrane Plasma‐Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis‐Dependence

2016

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In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line). All tandem procedures were feasible, efficient and safe. No serious side-effects were recorded. The most elegant setup was the procedure with independent, parallel blood circuits. However, serial tandem procedures provided for the elimination of citrate and normalization of electrolytes before blood was returned to the patient.

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Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Cited by 21 publications

References 13 publications

Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

Membrane‐filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety

Single-Pass Albumin Dialysis in the Treatment of Children with Liver Failure

Citrate Anticoagulation in Tandem Membrane Plasma‐Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis‐Dependence

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