Introduction
Double‐filtration plasmapheresis (DFPP) has been utilized for immunomodulation in kidney transplantation. Anticoagulation is important to maintain circuit patency during DFPP. We aimed to compare the efficacy and safety of regional citrate anticoagulation (RCA) with systemic heparin anticoagulation during DFPP in kidney transplant recipients.
Methods
A retrospective cohort study was conducted to compare the efficacy and safety of RCA (RCA‐DFPP) to systemic heparin anticoagulation (Hep‐DFPP) for DFPP among kidney transplant recipients in a single tertiary center.
Results
A total of 112 sessions of DFPP were performed for 23 subjects, of which 62 sessions were RCA‐DFPP and 50 sessions were Hep‐DFPP. There were 13 sessions (11.6%) of premature circuit clotting, 10 sessions (16.1%) for RCA‐DFPP and 3 sessions (6.0%) for Hep‐DFPP (P = .10). All premature circuit clotting episodes occurred in subjects who underwent DFPP through a vascular catheter. Premature circuit clotting was associated with the use of a vascular catheter (odds ratio [OR] 14.2, 95% confidence interval [CI] 2.7‐73.7; P < .01) and high postfilter ionized calcium (OR 12.7, 95% CI 1.4‐112.5; P < .01). There was no major bleeding event. Hep‐DFPP was associated with higher occurrence of hypocalcemia (OR 1.1, 95% CI 1.0‐1.2; P < .01) and metabolic acidosis (OR 1.4, 95% CI 1.2‐2.0; P = .04), while hypomagnesemia was more common for RCA‐DFPP (OR 2.9, 95% CI 1.1‐7.4; P = .03).
Conclusion
Amongst kidney transplant patients who receive DFPP therapy, RCA‐DFPP may be comparable to Hep‐DFPP for the maintenance of circuit patency. Functioning vascular access is vital in avoiding premature clotting of the circuit. Close monitoring of electrolyte imbalances and coagulopathy related to DFPP is recommended.
Kidney transplantation offers improved mortality and morbidity compared to dialysis in patients with end-stage kidney disease (ESKD) and is the preferred renal replacement therapy of choice. With their improved health status, kidney transplant recipients (KTRs) may seek care in the community as the first line of medical attention. With the increasing prevalence of ESKD in Singapore, family physicians will play an expanded role in the care of the KTR. To avoid allograft rejection, KTRs are on lifelong immunosuppressive therapy which has potential for adverse drug-drug interactions and drug toxicity. It would be prudent to be aware of potential interactions between immunosuppressive agents and commonly prescribed medications in the primary care setting.
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