Tandem plasmapheresis and continuous kidney replacement treatment in pediatric patients

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.

Tandem Therapeutic Plasma Exchange Reduces Continuous Renal Replacement Therapy Downtime

“…There is scant literature on the use of TPE in children. Recently, Pekkucuksen et al [13] reported on their experience with TPE also at a large institution in 63 pediatric patients with a similar range of clinical diagnoses when compared to our study. In contrast to our study, they did not investigate the impact of tandem TPE on circuit downtime, but importantly the authors report on the safety of concurrent CRRT with TPE.…”

“…Our study has a number of positive features that lend credence to our findings. Our patient population undergoing concurrent CRRT and TPE both before and after initiation of the tandem TPE protocol is comparable to or larger than similar reports [7, 13, 16]. Our broad inclusion criteria, with all patients undergoing CRRT during the study period included in the analysis, are also a strength with respect to the generalizability of our findings.…”

“…In contrast to our study, they did not investigate the impact of tandem TPE on circuit downtime, but importantly the authors report on the safety of concurrent CRRT with TPE. Although all patients remained asymptomatic, hypocalcemia occurred in their study population (72% of treatments) at an increased frequency relative to previously published studies on CRRT and TPE in isolation [13]. Close monitoring of ionized calcium levels is particularly important when using the 2 therapies in tandem.…”

“…Compared to the established method of discontinuing CRRT during TPE, tandem TPE is designed to avoid prolonged periods of fluid accumulation and reduced clearance. While recent reports have described patient outcomes after undergoing tandem TPE, studies evaluating the effect of tandem therapy on CRRT circuit downtime in pediatric patients are lacking [13]. We sought to examine the factors associated with CRRT downtime at a quaternary children's hospital and to analyze the effect of adopting a concurrent CRRT and TPE technique on CRRT circuit downtime.…”

Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

“…This was alternated with combined plasma exchange and haemodialysis (for n = 8). Plasma exchange was 1.5 × plasma volume 5/10 (50%) died 3/10 (30%) others were successfully transplanted 2/10 (20%) had native liver survival Patients showed significantly greater reductions in bilirubin, ammonia and INR on PE/HD than on MARS/mini-MARS ( p < 0.05) Tufan Pekkucuksen et al 2020 [ 48 ] 2013–2016 USA Retrospective observational cohort study n = 63 ( n = 20, 32% TPE for ALF or ACLF) Tandem continuous veno-venous haemodiafiltration and plasma exchange. For plasma exchange; mean exchange volume 1.34 + / − 0.21.…”