Coupled plasma filtration and adsorption (CPFA)

A single center experience

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)891-896
Number of pages6
JournalNephro-Urology Monthly
Volume5
Issue number4
Publication statusPublished - 2013

Fingerprint

Adsorption
Sepsis
Patient Care Bundles
Fungemia
Mortality
Therapeutics
Immunosuppressive Agents
Resuscitation
Serum Albumin
Citric Acid
Myocardial Ischemia
Heparin
Comorbidity
Albumins
Diabetes Mellitus
Anti-Inflammatory Agents
Hemodynamics
Anti-Bacterial Agents
Hypertension

Keywords

  • Mortality
  • Plasma Filtration
  • Sepsis

ASJC Scopus subject areas

  • Urology

Cite this

Coupled plasma filtration and adsorption (CPFA) : A single center experience. / Abdul Cader, Rizna; Abdul Gafor, Abdul Halim; Mohd, Rozita; Kong, Wei Yen; Arshad, Norazimah; Kong, Norella.

In: Nephro-Urology Monthly, Vol. 5, No. 4, 2013, p. 891-896.

Research output: Contribution to journalArticle

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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.",
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