Hemodynamic effects of the different vascular accesses used for double-filtration plasmapheresis

Systematic investigations of hemodynamic status during double filtration pl asmapheresis (DTP) are rare in the literature. To investigate the hemodynam ic effects of the vascular access chosen for DFP, variations in blood press ure (BP) and pulse rate (PR) induced acutely by DFP were prospectively anal yzed in 46 myasthenia gravis (MG) patients a standard DFP protocol with iso volumetric saline fluid replacement. BP and PR were monitored at 30-min int ervals (baseline, M30, M60, M90, and M120) during the procedures. The patie nts were randomized into central vein (CV) and peripheral vein (PV) groups based on the vascular access used: Systolic BP (SBP) dropped significantly at M60 (P < 0.05), M90 (P < 0.001), and M120 (P < 0.001) when compared to t he baseline level. Symptomatic hypotension was not observed in any of the 4 6 sessions. SBP values during DFP in the CV group were significantly lower than the PV group's at M60 (93.1 vs. 101.0%; P < 0.05) and marginally lower at M90 (91.2 vs. 97.2%, P = 0.06). There was no significant difference in diastolic BP changes between the two groups. In the CV and PV groups, PR ch anges during plasmapheresis also differed at M90 (103.4 vs. 94.5%, P < 0.00 1) and M120 (101.3 vs. 95.0%, P < 0.05). The significantly lower SBP during DFP in the CV group at M60 may be due to the high central vein flow rate a nd resultant delay in volume replacement. In conclusion, the vascular acces s selected for DFP plays a role in the pathogenesis of plasmaphecesis-relat ed hypotension. Controlling flow rates may help to prevent hypotension. (C) 2001 Wiley-Liss, Inc.