The Efficacy and Safety of Slow Plasma Exchange Plus Continuous Hemodiafiltration for Severe Kawasaki Disease

Abstract

Background: Intravenous immunoglobulin (IVIG) is an effective treatment for Kawasaki disease. However, severe Kawasaki disease can be refractory to IVIG. The aim of the present study was to investigate the efficacy and safety of slow plasma exchange plus continuous hemodiafiltration (SPE＋CHDF) for severe Kawasaki disease.
Materials and Methods: Since September 2007, we have performed SPE＋CHDF for severe Kawasaki disease in 12 cases at our facility.
Results: With respect to cardiac function before SPE＋CHDF, atrial natriuretic peptide (ANP) values (222.4±172.9 pg/mL), brain natriuretic peptid (BNP) values (425.8±605 pg/mL) and cardiothoracic ratio (56.3±5.6％) were high in all patients. There were no significant changes in heart rate or systolic blood pressure at 1 h and 3 h after SPE＋CHDF compared with results before therapy. There were no cases of intravascular catheter infection, ventilator-associated pneumonia cases or requirement for inotropic agents. All patients became afebrile 1–4 days (median, 1 day) after SPE＋CHDF. However, we performed additional treatment in two cases due to recurrence. Seven cases with a coronary artery lesion before SPE＋CHDF regressed within 1 year.
Conclusion: Plasma exchange is effective for the treatment of severe Kawasaki disease. However, many cases of severe Kawasaki disease involve hemodynamic failure. Our data suggest that SPE＋CHDF can be used to safely perform plasma exchange in these cases.