Kidney Week

Abstract: TH-PO1204

Therapeutic Plasma Exchange and CRRT in Children with Multiple Organ Dysfunction Syndrome

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Krieger, Samantha Lou, Stanford University, Stanford, California, United States

Samantha Lou Krieger, MD

• Salvatore, Anthony, Seattle Children's Hospital, Seattle, Washington, United States

Anthony Salvatore, DO

• Pollack, Ari, Seattle Children's Hospital, Seattle, Washington, United States

Ari Pollack, MD

• Smith, Jodi M., Seattle Children's Hospital, Seattle, Washington, United States

Jodi M. Smith, MD, MPH

• Sutherland, Scott M., Stanford University, Stanford, California, United States

Scott M. Sutherland, MD

• Menon, Shina, Stanford University, Stanford, California, United States

Shina Menon, MD, FASN

Background

Extracorporeal blood purification (EBP) techniques like therapeutic plasma exchange (TPE) are used in patients with multiple organ dysfunction syndrome (MODS) secondary to sepsis or SIRS (systemic inflammatory response syndrome), with limited guidelines on patient selection. Studies show lower MAKE-90 [major adverse kidney events at 90 days; a composite of death, need for renal replacement therapy (RRT), or >25% decline in estimated glomerular filtration rate (eGFR) from baseline] in patients with MODS on CRRT who had new thrombocytopenia. We aimed to describe the clinical characteristics and outcomes including MAKE-90 in such a cohort.

Methods

Retrospective cohort study of patients from birth to 25 years old admitted to the ICUs at 2 centers from 2017 to 2025 and managed with CRRT and TPE. Patients were categorized into 3 cohorts: Sepsis and New Thrombocytopenia (platelets <100,000/mm3 or ≥50% drop from baseline), Sepsis with prior Thrombocytopenia, and SIRS (inflammation with no infection). Primary outcome was MAKE-90.

Results

66 patients (52% female, median (IQR) age 5.3 years (1.1–13.6)) included (Figure 1). All patients with SIRS had MAKE-90 compared to 74% in Sepsis and New Thrombocytopenia (p=0.011). Survival to discharge was similar across the cohorts (p=0.82). Patients with SIRS had longer CRRT duration and ICU length of stay compared to Sepsis and New Thrombocytopenia. 90-day eGFR was lowest in patients with SIRS; 75.2 (44.4–112.5) compared to 150.7 (107–202.4) mL/1.73 m2/min in those with sepsis and new thrombocytopenia (p=0.009).

Conclusion

MAKE-90 was highest in those with SIRS with a higher proportion being dialysis dependent at 90 days and lower eGFR in those not on dialysis. TPE may not be the optimal EBP strategy for all patients with MODS, and a targeted approach is needed to identify patients likely to benefit from this therapy.