Abstract: TH-PO776
Tandem Plasmapheresis on Continuous Renal Replacement Therapy in Pediatrics
Session Information
- Pediatric CKD
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1700 Pediatric Nephrology
Authors
- Tufan pekkucuksen, Naile, University of FLorida, Gainesville, Florida, United States
- Sigler, Katharine, Texas Children's Hospital, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
- Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
Background
Plasmapheresis (TPE) has been used successfully to reduce concentration of pathogenic antibodies, immune complexes, cryoglobulins and lipoproteins Continuous renal replacement therapy (CRRT) is the treatment modality for acute kidney injury, fluid overload and electrolyte and metabolic imbalance for unstable patients. Reported experience about simultaneous use of TPE and CRRT (referred to as tandem TPE) in pediatric (ped) patients (pts) is scarce.
Methods
We describe tandem TPE experience from our institution. Retrospectively reviewed ped pts receiving tandem TPE from 2013 to 2016. Centrifugal based TPE was performed, all CRRT patients received hemodiafiltration at minimum starting dose of 2000 ml/1.73m2/hour with regional citrate anticoagulation. For tandem TPE apheresis lines were “Y”ed in the circuit in parallel without using additional anticoagulation.
Results
63 pts received tandem TPE, for a total 378 of TPE procedures on 1676 days of CRRT. Age ranged from newborn to 19 years old, weights ranged from 2.31 to 112.3 kg (17 pts were <10 kg and < 1 year old). Most common indications were coagulopathy and hepatic encephalopathy caused by acute liver failure (20 pts), thrombocytopenia associated multi-organ failure (TAMOF) (19 pts) and thrombotic microangiopathy (5pts). Median number of TPE session per pt was 5 (IQR:3;7). Median number of CRRT days was 12 (6; 37). All treatments were completed successfully. 57 (90%) patients had hypocalcemia and 59 (94%) patients had hypercalcemia at least one time during the treatments. 27 (43%) patients had citrate accumulation (defined by plasma total calcium/ionized calcium >2.5 mmol) during the treatments. All episodes were asymptomatic. Case mortality rate was 40%. Time to CRRT and TPE initiation was longer in non-survivors (NoS) vs survivors (3 d (1,9) vs 1 (1,2) & 4 d (2,13) vs. 2 (1,3) TPE) (p=0.02). PRISM score at ICU admission of NoS is significantly higher (p=0.031).
Conclusion
Tandem TPE treatment during CRRT can be effectively used in pediatric pts over a broad age and weight range. Complications including hypocalcemia are common though pts remained asymptomatic. Complex treatments need to be planned carefully with interdisciplinary team to address indications, technicalities and complications.