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ASN / Education & Meetings / Kidney Week /

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Abstract: TH-PO042

Safety and Clinical Efficacy of Plasma-Saving Membrane-Based Therapeutic Plasma Exchange (mTPE) in the Critically Ill Patients Undergoing Continuous Renal Replacement Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Author

  • Ahn, Jae Sung, Asan Medical Center, Songpa-gu, Seoul, Korea (the Republic of)
Background

The mTPE eliminating endotoxin, cytokine and abnormal antibody could be beneficial. To minimize adverse reaction caused by fresh frozen plasma (FFP) and bleeding risk, we used 5-20% albumin, crystalloid fluid and 8 units of FFP as replacement solution. We investigated bleeding event, the changes of platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT) and 28-Day mortality rate as primary outcome.

Methods

In this retrospective study, 118 mTPE sessions were performed in 60 patients (age 59.6±14.4 years, M:F=34:26) undergoing CRRT and receiving antibiotics and vasopressors for severe sepsis/shock (n=43), inflammatory disease (n=12) and others (n=5). Our subjects were divided into four groups according to the SOFA score: I (0-9, predicted mortality rate <10%), II (10-12, 10-30%), III (13-14, 40-60%), and IV (15-24, > 75%). mTPE was repeated with the interval of 24-48 hours up to 10 times, If needed.

Results

There was no significant difference in SOFA scores, mean arterial pressure, vasopressor index score and PT. The hemoglobin (8.8±2.0 vs. 8.4±2.0 g/dL, p=0.021) and platelet count (96K±101K vs. 80K±86K /mm3, p=0.001) were significantly decreased after 1st mTPE. aPTT was significantly increased from 62.7±38.6 to 74.5±41.2 seconds (p=0.037). The similar changes persisted after 2nd mTPE. However, there was no bleeding event within 24 hours from the end of mTPE sessions. The 28-Day mortality rates were 22.2%, 12.5%, 0% and 67.6% in the 4 groups, respectively. Analyzing survival according to the number of mTPE application, 14 patients survived among 29 who received only one time of mTPE and 4 among 20, two times of mTPE. Only 2 patients survived among 11 who received three time or more of mTPE.

Conclusion

Despite aPTT prolongation and decreased hemoglobin and platelet count, no bleeding events and lower-than-expected mortality suggest that mTPE could be safe and beneficial in these patients.