Tandem hemodialysis and plasma exchange

Filler, Guido; Clark, William F.; Huang, Shih‐Han S.

doi:10.1007/s00467-013-2620-7

Cited by 14 publications

(21 citation statements)

References 20 publications

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“…Case series from adult patients with immune-mediated disease indeed indicate a time-saving effect (3)(4)(5)(6). In a recent survey, 23 of 25 pediatric nephrology centers confirmed the demand for combined PE/HD (cPE/HD) treatment, mainly in children with atypical hemolytic uremic syndrome (HUS) and vasculitis, but also in children with renal graft rejection and recurrent FSGS (7). A case series of eight children in an Italian pediatric center suggests the feasibility of tandem dialysis (8).…”

Section: Introductionmentioning

confidence: 98%

Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Betti

Újszászi

Schaefer

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Patients with immune-mediated kidney disease and liver failure often require plasma exchange (PE) and hemodialysis (HD). Combining both methods (i.e., connecting the PE and HD circuits in series [tandem dialysis]) should allow for a more efficient treatment. This work reviews the authors' experience with tandem blood purification. Results The mean treatment duration was 3.862.2 hours per cPE/HD and 5.961.6 hours per sPE/HD session (P,0.001). Dialyzer surface areas per body surface area (in meters squared) and blood flow rates were similar. Although a 3-fold higher initial bolus of heparin was administered with cPE/HD, the heparin dose per hour was similar with both modalities and the total heparin load was only slightly lower with cPE/HD, with a median 2939 IU/m 2 per session (interquartile range, 1868, 4189) versus 3341 IU/m 2 per session (interquartile range, 2126, 4792). In sessions with regional anticoagulation, equal citrate and calcium infusion rates were applied. Plasma turnover, ultrafiltration rates, and solute removal were comparable. Procedure-related problems developed in 14.0% of cPE/HD and 7.0% of sPE/HD sessions (P=0.37). Clinical symptoms occurred in 19.6% and 6.2% (P=0.05), necessitating treatment discontinuation in 12.0% and 5.3% of the sessions (P=0.14). Intraindividual comparison of both dialysis methods in 11 children reconfirmed these findings.Conclusions cPE/HD is a time-saving procedure relative to sPE/HD, but may be associated with a higher rate of procedure-related and clinical adverse events.

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Section: Introductionmentioning

confidence: 98%

Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Betti

Újszászi

Schaefer

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…1). Patients who have received tandem TPE with intermittent hemodialysis (HD) in both adults and children have been described [3][4][5][6][7][8][9][10][11]. Yorgin et al described the use of plasmapheresis during CKRT in 2000 [12].…”

Section: Introductionmentioning

confidence: 99%

Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients

et al. 2020

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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.

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“…14 Other studies have reported on tandem TPE and hemodialysis (HD) in adults and children. [15][16][17][18][19][20][21][22] Unlike in the mentioned studies, we have used easily available Yconnectors to establish parallel or sequential (seriesparallel) connections at the vascular catheter or in the CKRT return/efferent line, respectively. In addition, we also report in our study on the technical and metabolic parameters during TPE-CKRT.…”

Section: Discussionmentioning

confidence: 99%

Description of parallel and sequential configurations for concurrent therapeutic plasma exchange and continuous kidney replacement therapy in adults

Kaushik

Liew

Sewa

et al. 2020

J of Clinical Apheresis

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Therapeutic plasma exchange (TPE) and continuous kidney replacement therapy (CKRT) are extracorporeal therapeutic procedures often implemented in management of patients. Critically ill patients may be afflicted with disease processes that require both TPE and CKRT. Performing TPE discontinuous with CKRT is technically easier, however, it disrupts CKRT and may compromise with CKRT efficiency or hemofilter life. Concurrent TPE with CKRT offers several advantages including simultaneous control of disease process and correction of electrolyte, fluid, and acid-base disturbances that may accompany TPE. Additionally, TPE may be performed by either centrifugation method or membrane plasma separation method. The technical specifications of these methods may influence the methodology of concurrent connections. This report describes and reviews two different approaches to circuit arrangements when establishing concurrent TPE and CKRT.

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Tandem hemodialysis and plasma exchange

Cited by 14 publications

References 20 publications

Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Safety and Efficacy of Tandem Hemodialysis and Plasma Exchange in Children

Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients

Description of parallel and sequential configurations for concurrent therapeutic plasma exchange and continuous kidney replacement therapy in adults

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