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Coupled Plasma Filtration and Adsorption (CPFA): A Single Center Experience.

Abdul Cader R, Abdul Gafor H, Mohd R, Yen Kong W, Arshad N, Kong N - Nephrourol Mon (2013)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

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.

Objectives: The main objective was to review our centers' experience with CPFA in septic patients.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus

CPFA Circuit With Continuous Renal Replacement Therapy
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fig5478: CPFA Circuit With Continuous Renal Replacement Therapy

Mentions: CPFA consists of filtration, adsorption and hemofiltration. During the filtration phase, plasma is separated from blood using a plasma filter. This separated plasma then passes through a sorbent cartridge where a specific resin allows nonspecific adsorption of pro and anti-inflammatory mediators and endotoxins (13, 14). Adsorption is the accumulation of molecules on the surface of a sorbent material depending on the membrane material, pH, ionic strength and pore size (10, 13, 15). There is no contact of red blood cells, white blood cells and platelets with the sorbent, thereby preventing treatment induced thrombocytopenia. The plasma filtrate is regenerated and returned to combine with blood thereby avoiding unwanted losses. CPFA can be used with a hemofilter for additional blood purification and removal of excess fluid in the presence of acute kidney injury (Figure 1).


Coupled Plasma Filtration and Adsorption (CPFA): A Single Center Experience.

Abdul Cader R, Abdul Gafor H, Mohd R, Yen Kong W, Arshad N, Kong N - Nephrourol Mon (2013)

CPFA Circuit With Continuous Renal Replacement Therapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3842560&req=5

fig5478: CPFA Circuit With Continuous Renal Replacement Therapy
Mentions: CPFA consists of filtration, adsorption and hemofiltration. During the filtration phase, plasma is separated from blood using a plasma filter. This separated plasma then passes through a sorbent cartridge where a specific resin allows nonspecific adsorption of pro and anti-inflammatory mediators and endotoxins (13, 14). Adsorption is the accumulation of molecules on the surface of a sorbent material depending on the membrane material, pH, ionic strength and pore size (10, 13, 15). There is no contact of red blood cells, white blood cells and platelets with the sorbent, thereby preventing treatment induced thrombocytopenia. The plasma filtrate is regenerated and returned to combine with blood thereby avoiding unwanted losses. CPFA can be used with a hemofilter for additional blood purification and removal of excess fluid in the presence of acute kidney injury (Figure 1).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Unit, Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.

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.

Objectives: The main objective was to review our centers' experience with CPFA in septic patients.

Patients and 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.

No MeSH data available.


Related in: MedlinePlus