title: Coupled Plasma Filtration and Adsorption (CPFA): A Single Center Experience.
abstract: BACKGROUND
  Coupled plasma filtration adsorption (CPFA) is a novel extracorporeal blood purification therapy for sepsis which adsorbs both proinflammatory and anti-inflammatory mediators from filtered plasma, thereby achieving early haemodynamic stability and a reduction in inotropic support requirement.
  
  
  OBJECTIVE
  The main objective was to review our centers' experience with CPFA in septic patients.
  
  
  METHODS
  A retrospective chart review of all septic patients who received CPFA was performed. All patients were initially treated according to the 'surviving sepsis care bundle' with fluid resuscitation, antibiotics, and inotropes as required. CPFA was started as soon as possible after a nephrologists' assessment.
  
  
  RESULTS
  Twenty five patients with sepsis received CPFA (15 M, 10 F, mean age 49.60 ± 18.97 years). Comorbidities included hypertension (n = 10, 40%), diabetes mellitus (n = 6, 24%), ischemic heart disease (n = 6, 24%), and an immunosuppressed state (n = 10, 40%). All patients received one cycle of CPFA with median duration of 5 (1-10) hours. CPFA was well tolerated but we encountered technical problems, especially filter clotting as CPFA was performed heparin free. 14 (56%) patients died within 28 days of treatment. CRP correlated with PCT (P = 0.040) and had an inverse trend with albumin (P = 0.066). Serum albumin was a strong predictor of mortality.
  
  
  CONCLUSIONS
  The high prevalence of fungaemia and mortality could be attributed to many patients on chronic immunosuppressive therapy. Nonetheless, CPFA albeit expensive, does add to our armamentarium of extracorporeal treatment for severe sepsis. Regional citrate anticoagulation with CPFA may overcome problems with filter clotting.
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Rizna
authors.initials: R
authors.lastname: Abdul Cader
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Halim
authors.initials: H
authors.lastname: Abdul Gafor
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Rozita
authors.initials: R
authors.lastname: Mohd
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Wei
authors.initials: W
authors.lastname: Yen Kong
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Norazimah
authors.initials: N
authors.lastname: Arshad
authors.affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Norella
authors.initials: N
authors.lastname: Kong
keywords: Mortality; Plasma Filtration; Sepsis