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Plasma exchange in patients with acute renal failure in the course of multiorgan failure
B G Stegmayr1, S Jakobson, A Rydvall
1Dept Internal Medicine, University Hospital, Umeå, Sweden.
Abstract:
Multiorgan failure (MOF) due to intoxication, trauma or sepsis in the progressive late stages always include acute renal failure (ARF). The prognosis of these patients is poor despite adequate dialysis. This study included 27 consecutive patients (20 men and 7 women, age range 15-77 years) with a rapid progress of MOF including ARF, who were treated by plasma exchange as an attempt to reverse the progress of MOF. Twenty-three of the patients suffered from a septic shock. Oliguria or anuria was present in all, dialysis was performed in 16 of them, and mechanical respiratory aid in 17. Plasma exchange was performed 1-10 times and almost exclusively by centrifuge technique, using albumin and/or liquid stored plasma (in a few cases fresh frozen plasma) as colloidal replacement fluid. Twenty-two patients survived (81%) and 5 patients died. The reasons of death were cerebral haemorrhagia, brain abscess, myocardial sudden death, relapsing sepsis from multiple hepatic abscesses and a not drained psoas abscess. All survivors could leave hospital recovered from renal failure with few other sequelae. The plasma exchange technique is easy to perform despite low blood pressures by using a vein to vein access. Plasma exchange, therefore, may be tried to reverse late stages of multiorgan failure.
Insights
Plasma exchange effectively treated multiorgan failure (MOF) including acute renal failure (ARF) in critically ill patients. This intervention improved survival rates and renal recovery, offering a potential treatment for advanced MOF.
Area of Science:
- Nephrology
- Critical Care Medicine
- Immunology
Background:
- Multiorgan failure (MOF) is a severe condition often involving acute renal failure (ARF), with a poor prognosis despite dialysis.
- Sepsis is a common cause of MOF, leading to complications like oliguria or anuria.
Purpose of the Study:
- To evaluate the efficacy of plasma exchange (PE) in reversing the progression of late-stage MOF.
- To assess the impact of PE on survival and renal function in patients with MOF and ARF.
Main Methods:
- A study of 27 patients with rapidly progressing MOF and ARF, 23 of whom had septic shock.
- Treatment involved 1-10 sessions of plasma exchange using albumin or plasma as replacement fluid.
- Patients received supportive care including dialysis and mechanical ventilation as needed.
Main Results:
- Twenty-two out of 27 patients (81%) survived the treatment.
- All survivors recovered from renal failure with minimal sequelae.
- Causes of death in the 5 non-survivors included cerebral hemorrhage, brain abscess, and sepsis.
Conclusions:
- Plasma exchange is a feasible and effective treatment for advanced multiorgan failure, including acute renal failure.
- The procedure can be safely performed even in hypotensive patients using a venous-to-venous access.
- Plasma exchange offers a promising therapeutic option for patients with severe, progressive MOF.