Citrate Anticoagulation in Tandem Membrane Plasma-Exchange or Immunoadsorption and Hemodialysis in Patients With Immunological Diseases and Dialysis-Dependence.
In 1996 we performed tandem membrane plasma exchange-hemodialysis in a 3-year-old girl and tandem immunoadsorption-hemodialysis with citrate as the only anticoagulant in a patient with Goodpasture's syndrome. In the present study, we evaluated the feasibility, efficacy and safety of 24 tandem plasma exchange/immunoadsorption hemodialysis procedures in four different circuit setups with citrate as the only anticoagulant. In two setups, the tandem procedures were connected in series (plasma exchange hemodialysis and immunoadsorption hemodialysis), while in the other two setups they were in parallel (plasma exchange hemodialysis with independent blood circuits and plasma exchange hemodialysis with independent arterial blood lines, but with a common return line). All tandem procedures were feasible, efficient and safe. No serious side-effects were recorded. The most elegant setup was the procedure with independent, parallel blood circuits. However, serial tandem procedures provided for the elimination of citrate and normalization of electrolytes before blood was returned to the patient.
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Rafael
R
Ponikvar
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Jakob
J
Gubenšek
Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Jadranka Buturović
JB
Ponikvar
D000328:Adult; D000368:Aged; D019867:Anti-Glomerular Basement Membrane Disease / Q000628:therapy; D000925:Anticoagulants / Q000008:administration & dosage*; D019343:Citric Acid / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007154:Immune System Diseases / Q000628:therapy; D007163:Immunosorbent Techniques; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D055815:Young Adult
D000925:Anticoagulants; D019343:Citric Acid
Hemodialysis; Immunoadsorption; Plasma exchange; Regional citrate anticoagulation; Tandem procedures