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Maurizi-Balzan J, Jouve T, Naciri-Bennani H, Noble J, Tanoukhi K, Motte L, Malvezzi P, Rostaing L. [How to implement a complete apheresis program within a hemodialysis unit]. Nephrol Ther 2019; 15:439-447. [PMID: 31585841 DOI: 10.1016/j.nephro.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 12/13/2022]
Abstract
Many apheresis techniques can be performed in a blood-bank facility or a hemodialysis (HD) facility. However, it makes sense to perform apheresis in a hemodialysis facility as apheresis involves extra-corporeal circuits and because HD can be performed at the same time as apheresis (tandem procedure). Apheresis techniques comprise therapeutic plasma exchange, double-filtration plasmapheresis, and its derivative (rheopheresis and LDL-apheresis), and immunoadsorption (specific and semi-specific). We have setup an apheresis platform in our hospital that fulfills health recommendations. This process has involved financial investment and significant human resources, and has enabled us to network with different specialties (neurology, hematology, vascular medicine). We have setup protocols according to the type of pathology to be treated by apheresis, and to monitor clinical and biological data for each apheresis session. The main side effects of apheresis are a fall in blood pressure when a session is initiated, an increase in fluid overload, hypocalcemia, and the loss of some essential plasmatic factors. However, these side-effects are easily identified and can be properly managed in real time. Within two-years, we have performed 1845 apheresis sessions (134 patients). Of these, 66 received apheresis before and/or after kidney transplantation for ABO and/or HLA incompatibility (desensitization), for humoral rejection, or in the setting of relapsing focal-segmental glomerulosclerosis. Our patients' outcomes have been similar to those reported in the literature. The other 68 patients had various conditions. Because our program is now well-established, we are currently forming a specialist center to train physicians and nurses in the various apheresis techniques/procedures.
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Affiliation(s)
- Jocelyne Maurizi-Balzan
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France.
| | - Thomas Jouve
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Hamza Naciri-Bennani
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Johan Noble
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Khadija Tanoukhi
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Lionel Motte
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Paolo Malvezzi
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
| | - Lionel Rostaing
- Service de Néphrologie Hémodialyse Aphérèses et Transplantation rénale, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 09, France
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Jagdish K, Jacob S, Varughese S, David VG, Mohapatra A, Valson A, Tulsidas K, Veerasami T, Alexander S. Effect of Double Filtration Plasmapheresis on Various Plasma Components and Patient Safety: A Prospective Observational Cohort Study. Indian J Nephrol 2017; 27:377-383. [PMID: 28904434 PMCID: PMC5590415 DOI: 10.4103/ijn.ijn_64_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Double filtration plasmapheresis (DFPP) was historically used for blood group incompatible renal transplantation. Very few studies are available worldwide regarding its efficiency in removing specific plasma components, and safety. We conducted a prospective observational cohort study over 1 year on patients undergoing DFPP for various renal indications. There were 15 patients with 39 sessions. The pre- and post-procedure plasma samples of serum IgG, IgA, IgM, fibrinogen, calcium, phosphate, potassium, and magnesium were analyzed. The effluent albumin concentration was also measured, and complications during the hospital stay were recorded. Cumulative removal of serum IgG, IgA, IgM, fibrinogen, and albumin at the end of four sessions were 72%, 89%, 96%, 88.5%, and 21.3%, respectively and effluent albumin concentration was 1.75 – 2.0 times (range: 6.3 g/dl – 7.2 g/dl; mean ± standard deviation (SD) – 7 g/dl ± 0.3 g/dl) the preprocedural serum albumin (mean ± SD – 3.5 g/dl ± 0.5 g/dl). Removal of other plasma components were not statistically significant. Hypotensive episodes were observed only 16.6%, with the usage of effluent concentration albumin as replacement fluid despite an average 2.4 (mean ± SD – 2.4 ± 0.4 l) liters of plasma volume processing each session. DFPP removes IgG, IgA, IgM, fibrinogen, and albumin. The cumulative removal IgG (72%) is suboptimal, whereas IgA (89%) and IgM (96%) are comparable to historical controls. We observed lesser episodes (12.5%) of hypotension with effluent albumin concentration as replacement fluid, and all bleeding complications were observed when serum fibrinogen level was <50 mg/dl.
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Affiliation(s)
- K Jagdish
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - V G David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - A Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - K Tulsidas
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - T Veerasami
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - S Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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