Therapeutic Plasma Exchange Is Associated With Improved Major Adverse Kidney Events in Children and Young Adults With Thrombocytopenia at the Time of Continuous Kidney Replacement Therapy Initiation.
Therapeutic Plasma Exchange Is Associated With Improved Major Adverse Kidney Events in Children and Young Adults With Thrombocytopenia at the Time of Continuous Kidney Replacement Therapy Initiation.
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DOI：
10.1097/cce.0000000000000891
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发表时间：
2023-04
影响因子：
--
通讯作者：
Arikan, Ayse Akcan
中科院分区：
文献类型：
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作者：
Fuhrman, Dana Y.;Thadani, Sameer;Hanson, Claire;Carcillo, Joseph A.;Kellum, John A.;Park, Hyun Jung;Lu, Liling;Kim-Campbell, Nahmah;Horvat, Christopher M.;Arikan, Ayse Akcan
关键词：
治疗性血浆置换（TPE）已被证明可改善血栓性微血管病和血小板减少症伴多器官衰竭患者的器官功能障碍和生存率。目前尚无已知的治疗方法可用于预防连续性肾脏替代治疗（CKRT）后的主要肾脏不良事件。本研究的主要目的是评价TPE对开始CKRT时患有血小板减少症的儿童和年轻成人的肾脏不良事件发生率的影响。回顾性队列。两家大型四级儿科医院。2014年至2020年期间接受CKRT的所有小于或等于26岁的患者。没有。我们将血小板减少症定义为CKRT开始时血小板计数小于或等于100，000（细胞/mm 3）。我们确定CKRT开始后90天（MAKE 90）的主要不良肾脏事件为死亡、需要肾脏替代治疗或估计肾小球滤过率较基线下降≥ 25%的复合事件。我们进行了多变量logistic回归和倾向评分加权，以分析TPE的使用与MAKE 90之间的关系。在排除诊断为血栓性血小板减少性紫癜和非典型溶血性尿毒综合征（n = 6）和慢性疾病导致的血小板减少（n = 2）的患者后，413例患者中有284例（68.8%）在CKRT开始时出现血小板减少（51%为女性）。血小板减少患者的中位（四分位距）年龄为69个月（13-128个月）。MAKE 90发生率为69.0%，41.5%接受TPE。通过多变量分析（比值比[OR]，0.35; 95% CI，0.20-0.60）和倾向评分加权（校正OR，0.31; 95% CI，0.16-0.59），TPE的使用与MAKE 90降低独立相关。血小板减少症在儿童和年轻人中常见，并且与MAKE 90增加相关。在该患者亚组中，我们的数据显示TPE在降低MAKE发生率方面的获益90。
Therapeutic plasma exchange (TPE) has been shown to improve organ dysfunction and survival in patients with thrombotic microangiopathy and thrombocytopenia associated with multiple organ failure. There are no known therapies for the prevention of major adverse kidney events after continuous kidney replacement therapy (CKRT). The primary objective of this study was to evaluate the effect of TPE on the rate of adverse kidney events in children and young adults with thrombocytopenia at the time of CKRT initiation. Retrospective cohort. Two large quaternary care pediatric hospitals. All patients less than or equal to 26 years old who received CKRT between 2014 and 2020. None. We defined thrombocytopenia as a platelet count less than or equal to 100,000 (cell/mm3) at the time of CKRT initiation. We ascertained major adverse kidney events at 90 days (MAKE90) after CKRT initiation as the composite of death, need for kidney replacement therapy, or a greater than or equal to 25% decline in estimated glomerular filtration rate from baseline. We performed multivariable logistic regression and propensity score weighting to analyze the relationship between the use of TPE and MAKE90. After excluding patients with a diagnosis of thrombotic thrombocytopenia purpura and atypical hemolytic uremic syndrome (n = 6) and with thrombocytopenia due to a chronic illness (n = 2), 284 of 413 total patients (68.8%) had thrombocytopenia at CKRT initiation (51% female). Of the patients with thrombocytopenia, the median (interquartile range) age was 69 months (13–128 mo). MAKE90 occurred in 69.0% and 41.5% received TPE. The use of TPE was independently associated with reduced MAKE90 by multivariable analysis (odds ratio [OR], 0.35; 95% CI, 0.20–0.60) and by propensity score weighting (adjusted OR, 0.31; 95% CI, 0.16–0.59). Thrombocytopenia is common in children and young adults at CKRT initiation and is associated with increased MAKE90. In this subset of patients, our data show benefit of TPE in reducing the rate of MAKE90.
影响因子：
3
作者：
Foglia MJ;Pelletier JH;Bayir H;Fleck A;Konyk L;McSteen C;Fisher D;Fuhrman DY
通讯作者：
Fuhrman DY