Risk of hypotensive reactions is increased when using partial saline replacement for therapeutic plasma exchange. J Clin Apher 2019 Oct;34(5):524-527
Date
03/20/2019Pubmed ID
30888726DOI
10.1002/jca.21703Scopus ID
2-s2.0-85063154379 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Partial normal saline replacement during plasma exchange procedures is a common practice to reduce procedure costs but may increase the risk of adverse events, such as hypotension and citrate reactions. The goal of this study was to compare adverse event rates for the patients that used albumin or albumin/saline as replacement.
STUDY DESIGN AND METHODS: A retrospective chart review was done of plasma exchange procedures that used all albumin or 80% albumin to 20% normal saline (80/20) as replacement. The procedure type (all albumin vs 80/20), the percent of normal saline used, age, gender, and adverse events during the procedure were recorded.
RESULTS: During the study period, 3624 procedures were documented for 401 patients (46% female), age range 0 to 93 years, of which 2453 (67.7%) used 80/20. Overall 91 procedures (2.5%) resulted in a hypotensive event, 26 (0.7%) of which were classified as moderate to severe hypotension, and 40 (1.1%) had reported citrate toxicity. After adjusting for age, gender, and diagnosis using a generalized linear mixed model and backward model selection, results showed that 100% albumin had a significantly lower risk of having hypotension than 80/20 (odds ratio (OR): 0.531 [0.298, 0.946], P = 0.032) and moderate to severe hypotension (odds ratio: 0.140 [95% confidence interval (CI): 0.031, 0.628], P = 0.010). Older age was also predictive of having hypotensive reactions (OR[95%CI] = 1.017,[1.0, 1.034], P = 0.047).
CONCLUSION: Partial saline use as a replacement fluid with albumin during plasma exchange is associated with an increased risk of hypotension. Use of saline as replacement fluid during plasma exchange should be minimized especially in older patients.
Author List
Irani MS, Toushan M, Zhang L, Simpson PM, Karafin MSAuthor
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Age Factors
Aged
Aged, 80 and over
Albumins
Child
Child, Preschool
Citrates
Female
Humans
Hypotension
Infant
Infant, Newborn
Male
Middle Aged
Plasma Exchange
Retrospective Studies
Sex Factors
Young Adult