Risk of hypotensive reactions is increased when using partial saline replacement for therapeutic plasma exchange

Area of Science:

• Nephrology
• Critical Care Medicine
• Hematology

Background:

• Plasma exchange (PLEX) commonly uses partial normal saline (NS) for cost reduction.
• This practice may elevate risks of adverse events, including hypotension and citrate toxicity.
• Albumin or albumin/saline mixtures are used as replacement fluids during PLEX.

Purpose of the Study:

• To compare adverse event rates between patients receiving PLEX with 100% albumin versus an 80% albumin/20% NS mixture.
• To identify risk factors associated with adverse events during PLEX.

Main Methods:

• Retrospective chart review of PLEX procedures.
• Data collected included replacement fluid type (100% albumin vs. 80% albumin/20% NS), patient demographics (age, gender), and adverse events.
• Statistical analysis using a generalized linear mixed model was performed to adjust for confounding variables.

Main Results:

• A total of 3624 procedures were analyzed. 67.7% utilized the 80% albumin/20% NS mixture.
• Hypotensive events occurred in 2.5% of procedures, with 0.7% classified as moderate to severe.
• 100% albumin replacement significantly reduced the risk of hypotension (OR: 0.531) and moderate to severe hypotension (OR: 0.140) compared to the 80/20 mixture.
• Older age was a predictor of hypotensive reactions (OR: 1.017).

Conclusions:

• Partial use of normal saline as a replacement fluid during PLEX is linked to a higher incidence of hypotension.
• Reducing or eliminating saline in replacement fluids during PLEX is advisable.
• Particular caution is warranted for older patients undergoing PLEX due to increased hypotension risk.