Abstract: FR-PO081
Membrane Therapeutic Plasma Exchange (mTPE) with Citrate Regional Anticoagulation: A Single-Center Experience
Session Information
- AKI: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Dias goncalves, Priscila, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
- Reis, Thiago A., CDRB - Clinica de Doencas Renais de Brasilia, Brasilia, DF., Brazil
- Freitas, Geraldo Rubens Ramos, USP, Brasilia, Brazil
Background
Membrane Therapeutic Plasma Exchange ( mTPE) is an extracorporeal blood therapy that uses convection through pressure applied upon a semi permeable membrane to remove from plasma elements such as antibodies, cytokines, lipids and viral particles. Usually, the anti coagulation method utilized is systemic unfractionated heparin( UFH). Coagulation components loss in mTPE in association with UFH enhances bleeding risk. Considering that risk, our center proposed the use of regional citrate anticoagulation as a safe option in patients undergoing mTPE. Below, we describe 12 sequential sessions performed using our citrate protocol.
Methods
mTPe was performed on the PrismaFlex with TPE 2000 membrane. We used 4% Sodium Citrate with a target concentration of 3mmol/L of treated blood. We delivered 10% Calcium gluconate to the patient at 3+-0.1mmol/L of effluent flow. A Solution 5% Albumin plus 10% Magnesium sulfate ( 1mmol/L) was used as replacement fluid. Within 2 hours of treatment we measured ionized calcium in the extracorporeal circuit, systemic ionized calcium and systemic magnesium.
Results
No changes were observed on serum concentrations of magnesium in all treatments. Median systemic ionized calcium concentration was 1,24mmol/L. No symptoms of hypocalcemia, arrhythmias or bleeding were reported. Median ionized calcium in the extracorporeal circuit was 0,36mmol/L. No sessions were interrupted due to system clotting. The median time of therapies was 170 minutes with similar costs to our center.
Conclusion
mTPE using regional citrate anticoagulation can be used by the nephrologist to provide a safe and cost effective option of plasma exchange. This modality of anticoagulation is an option for patients at risk or with active bleeding.
Variables of distribution : ionized calcium in the extracorporeal circuit, systemic ionized calcium and systemic magnesium.
Funding
- Private Foundation Support