title: Tandem plasma-exchange and haemodialysis in a paediatric dialysis unit.
abstract: BACKGROUND
  The simultaneous use of plasma-exchange (PE) and haemodialysis (HD), known as tandem PE and HD (TPH), may be an additional resource for treating patients who need both therapies at the same time. However, little experience is reported in the paediatric setting.
  
  
  METHODS
  We retrospectively reviewed the TPH sessions performed in the last 5 years in our unit. Thirty-nine TPH treatments in eight pediatric patients were traced. The median age of the patients was 10.5 (range 5.1-19.2) years, and median weight was 27.6 (range 14.7-66.2) kg. Indications for TPH were atypical haemolytic uremic syndrome due to factor H or factor I dysregulation, or to a not yet defined abnormality, in most of the sessions (34/39 sessions). The remaining five sessions were performed for vasculitis, focal segmental glomerulosclerosis and hyperimmunization in a patient waiting for kidney transplant. In all treatments, TPH was completed and reached the desired ultrafiltration and substitution volumes; the duration of PE was shorter than that of HD. No significant adverse events were observed.
  
  
  CONCLUSIONS
  In those rare patients who require both PE and HD, TPH can improve their quality of life by reducing the time spent in extracorporeal circulation. This tandem treatment is safe and well-tolerated, even in subjects of relatively small body size.
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabiopaglialonga@alice.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Antonietta
authors.initials: A
authors.lastname: Biasuzzi
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010951:Plasma Exchange; D006435:Renal Dialysis; D012189:Retrospective Studies