Introduction: Certain patients require simultaneous lipoprotein apheresis (LA) and intermittent hemodialysis (HD). Instead of undergoing 2 consecutive treatment sessions, a double filtration plasmapheresis (DFPP) and HD tandem procedure could be offered to reduce treatment times and costs. Our study evaluated the performance, safety and cost of this tandem procedure.
Material and methods: Three patients underwent 168 HD and DFPP tandem sessions in a tertiary center from August 2018 to November 2020, using a Fresenius 5008 generator for HD and an InfomedHF440 for DFPP. The system's efficacy was assessed by lipid subtraction performance for DFPP. Efficacy of 2 blood line connection configurations (parallel or sequential) was compared in terms of Kt/V and matched against an HD control session for each patient. Clinical and biological safety and the differential cost between tandem and consecutive procedures were evaluated.
Results: Throughout the tandem sessions, DFPP lasted 85 to 120 minutes, overlapping the 240-minute HD. Blood flow for HD and Kt/V were significantly lower during the tandem procedure with a parallel configuration compared to sequential or control paired HD. DFPP efficacy was comparable between all groups: over 60% reduction in cholesterol and over 50% for triglycerides. Symptomatic hypotension depended on the patients, not the procedure. The tandem procedure revealed an acceptable benefit-cost ratio.
Conclusion: HD-DFPP tandem with a sequential blood line connecting system (derivation installed on the HD venous line) is effective and well-tolerated with a good cost-benefit ratio. Tandem reduces hospitalization and treatment session times and can be offered to patients requiring simultaneous HD and DFPP.
Keywords: DFPP; hemodialysis; lipoprotein apheresis; tandem.
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