A Combined Circuit of Centrifugal Plasma Exchange and Continuous Hemodiafiltration in the Treatment of Atypical Hemolytic Uremic Syndrome in a Nine-Year-Old Boy

Abstract

In Japan, plasma exchange (PE) has traditionally been performed using membrane separation; however, centrifugal PE has recently been introduced. We present the case of a nine-year-old boy with atypical hemolytic uremic syndrome, who underwent continuous hemodiafiltration (CHDF) and centrifugal PE in a parallel configuration with a bypass line. This setup allowed the PE system to operate at a lower blood flow rate, while maintaining the required flow for the CHDF system. Two high-flow, three-way stopcocks were connected immediately after blood withdrawal from a double-lumen dialysis catheter in the CHDF circuit. The procedure was performed smoothly without any equipment malfunction or pressure alarms. Although centrifugal PE offers advantages when used alone, such as shorter treatment time and the possibility of peripheral access, these benefits are not realized when combined with CHDF. Moreover, the increased priming volumes and specific insurance requirements must be considered when combining both therapies. In Japan, although the procedure cost for PE is covered by insurance, the cost of the circuit used in the procedure is not reimbursed, which may result in additional expense.