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Abstract: SA-PO711

Therapeutic Plasma Exchange-Related Hypotension: A Comparison of Replacement Fluids

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Yanik, Andrew, University of Utah Health, Salt Lake City, Utah, United States
  • Sarwal, Amara, University of Utah Health, Salt Lake City, Utah, United States
  • Dwyer, Jamie P., University of Utah Health, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, University of Utah Health, Salt Lake City, Utah, United States
  • Boucher, Robert E., University of Utah Health, Salt Lake City, Utah, United States
  • Abraham, Josephine, University of Utah Health, Salt Lake City, Utah, United States
Background

Therapeutic plasma exchange (TPE) is used to remove specific pathogenic entities or replace substances that are physiologically lacking. TPE requires replacement fluid administration due to plasma losses, and the most common replacement fluids are albumin and saline. There is limited literature regarding the effect of different replacement fluids on TPE-related hypotension. This study aimed to compare TPE-related hypotension between groups receiving partial-saline and 100% albumin.

Methods

This is a retrospective, single-center study from the University of Utah. Patients who were 18 years old or older and had diagnoses necessitating TPE were considered eligible participants. 2272 TPE sessions were performed in 333 patients from 1/1/2020 and 3/3/2023. All patients before 3/1/22 received partial saline, and all patients after this received 100% albumin. Episodes of TPE-related hypotension were investigated and compared between these two groups using logistic regression models to relate TPE group to the incidence of each type of hypotensive event, with adjustment for SBP, DBP and indication for TPE.

Results

The mean age of the patients was 50.5 years and 48.6% were male. The partial-saline group accounted for 1432 sessions and the 100% albumin group accounted for 840. Hypotension occurred in 32.4% of TPE sessions in the partial saline group, and 31.7% in the albumin group (OR=1.01, 95% CI 0.83-1.23, p=0.865). When analyzing individual criteria of hypotension between the partial saline and albumin groups respectively, the results show: 4.82% vs 2.86% (SBP <90 mmHg OR=1.70, 95% CI 1.03-2.78, p=0.035), 16.13% vs 11.31% (MAP <65 OR=1.39, 95% CI 1.05-1.83, p=0.02), 21.37% vs 22.26% (SBP drop >20 mmHg OR=0.98, 95% CI 0.7-1.23, p=0.84), and 3.84% vs 2.50% (SBP drop >40 mmHg OR=1.74, 95% CI 1.00-3.03, p=0.05). When analyzing the composite of an SBP drop below 90 mmHg, MAP <65, and SBP drop by >40 mmHg, events occurred in 19.41% and 14.05 % of the partial saline and albumin groups, respectively (OR=1.41, 95% CI 1.09-1.80, p=0.007).

Conclusion

Partial saline recipients are significantly more likely to have a hypotensive event. This may reflect support for using 100% albumin as replacement fluid during TPE, reinforcing the physiologic rationale for colloid replacement.