Tandem Therapeutic Plasma Exchange Reduces Continuous Renal Replacement Therapy Downtime

Foglia, Matthew J; Pelletier, Jonathan; Bayır, Hülya; Fleck, Annette; Konyk, Leslie; McSteen, Coleen; Fisher, Dawn; Fuhrman, Dana Y.

doi:10.1159/000518348

Cited by 1 publication

(3 citation statements)

References 18 publications

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“…Furthermore, future studies exploring the questions we proposed in our study should be considered at centers that do not readily use TPE, whereby TPE initiation resources with a clearly defined protocol for implementation are provided. Given the increasing ease and published safety of providing TPE in tandem with CKRT ( 15 , 16 ), our findings further support the need to explore the use of TPE in patients with thrombocytopenia receiving CKRT in a larger prospective randomized multicenter study.…”

Section: Discussionsupporting

confidence: 64%

“…Both centers similarly exchange 1.3–1.5 times the patient’s calculated blood volume on day 1 of TPE, followed by a single volume exchange on subsequent days. Both centers have previously published their techniques for concurrent CKRT and TPE therapy ( 15 , 16 ).…”

Section: Methodsmentioning

confidence: 99%

“…For each final model, p values of less than or equal to 0.05 were considered statistically significant. All statistical analyses were performed using STATA 16…”

Section: Statistical Analysesmentioning

confidence: 99%

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Therapeutic Plasma Exchange Is Associated With Improved Major Adverse Kidney Events in Children and Young Adults With Thrombocytopenia at the Time of Continuous Kidney Replacement Therapy Initiation

Fuhrman¹,

Thadani

Hanson

et al. 2023

Critical Care Explorations

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OBJECTIVES: Therapeutic plasma exchange (TPE) has been shown to improve organ dysfunction and survival in patients with thrombotic microangiopathy and thrombocytopenia associated with multiple organ failure. There are no known therapies for the prevention of major adverse kidney events after continuous kidney replacement therapy (CKRT). The primary objective of this study was to evaluate the effect of TPE on the rate of adverse kidney events in children and young adults with thrombocytopenia at the time of CKRT initiation. DESIGN: Retrospective cohort. SETTING: Two large quaternary care pediatric hospitals. PATIENTS: All patients less than or equal to 26 years old who received CKRT between 2014 and 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We defined thrombocytopenia as a platelet count less than or equal to 100,000 (cell/mm 3 ) at the time of CKRT initiation. We ascertained major adverse kidney events at 90 days (MAKE90) after CKRT initiation as the composite of death, need for kidney replacement therapy, or a greater than or equal to 25% decline in estimated glomerular filtration rate from baseline. We performed multivariable logistic regression and propensity score weighting to analyze the relationship between the use of TPE and MAKE90. After excluding patients with a diagnosis of thrombotic thrombocytopenia purpura and atypical hemolytic uremic syndrome ( n = 6) and with thrombocytopenia due to a chronic illness ( n = 2), 284 of 413 total patients (68.8%) had thrombocytopenia at CKRT initiation (51% female). Of the patients with thrombocytopenia, the median (interquartile range) age was 69 months (13–128 mo). MAKE90 occurred in 69.0% and 41.5% received TPE. The use of TPE was independently associated with reduced MAKE90 by multivariable analysis (odds ratio [OR], 0.35; 95% CI, 0.20–0.60) and by propensity score weighting (adjusted OR, 0.31; 95% CI, 0.16–0.59). CONCLUSIONS: Thrombocytopenia is common in children and young adults at CKRT initiation and is associated with increased MAKE90. In this subset of patients, our data show benefit of TPE in reducing the rate of MAKE90.

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Section: Discussionsupporting

confidence: 64%

Section: Methodsmentioning

confidence: 99%