T F Hiemstra1, A Casian, P Boraks, D R Jayne, I Schoenmakers. 1. Divisions of Nephrology and Clinical Pharmacology, Department of Medicine, University of Cambridge, Box 118, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK. tfh24@cam.ac.uk.
Abstract
BACKGROUND: Plasma exchange is used in the treatment of diseases mediated by pathogenic circulating proteins, or for transplant desensitization. Its non-targeted nature results in the depletion of physiologically important molecules, and it is often complicated by hypocalcaemia. AIM: To determine the effects of plasma exchange on vitamin D binding protein (DBP) and associated vitamin D metabolites. DESIGN: Single-centre prospective cohort study of 11 patients. METHODS: DBP and vitamin D metabolites were measured before and immediately after five plasma exchanges, and 7 and 28 days after discontinuation of plasma exchange. RESULTS: Plasma exchange reduced plasma DBP concentration from 196.9 ± 53.2 to 98.5 ± 34 μg/ml (P = 0.0001), 1,25-dihydroxyvitamin D from 103 ± 52 to 42 ± 4 pmol/l (P = 0.003) and 25-hydroxyvitamin D from 49.7 ± 29 to 22 ± 9.4 nmol/l (P = 0.0017), through their removal in effluent. After 7 days, DBP and 1,25-dihydroxyvitamin D were not significantly different from baseline, but 25-hydroxyvitamin D remained significantly lower after 7 days (26.4 ± 9.8 nmol/l, P = 0.02) and 28 days (30.8 ± 15.5 nmol/l, P = 0.048). Corrected calcium decreased from 2.23 ± 0.11 to 1.98 ± 0.08 mmol/l (P = 0.0007) immediately after five treatments. Plasma calcium was significantly associated with 1,25-dihydroxyvitamin D (r(2) = 0.79, P < 0.0001). CONCLUSION: Plasma exchange induced an acute reversible decrease in plasma 1,25-dihydroxyvitamin D, DBP, calcium and a sustained decrease in plasma 25-hydroxyvitamin D.
BACKGROUND: Plasma exchange is used in the treatment of diseases mediated by pathogenic circulating proteins, or for transplant desensitization. Its non-targeted nature results in the depletion of physiologically important molecules, and it is often complicated by hypocalcaemia. AIM: To determine the effects of plasma exchange on vitamin D binding protein (DBP) and associated vitamin D metabolites. DESIGN: Single-centre prospective cohort study of 11 patients. METHODS: DBP and vitamin D metabolites were measured before and immediately after five plasma exchanges, and 7 and 28 days after discontinuation of plasma exchange. RESULTS: Plasma exchange reduced plasma DBP concentration from 196.9 ± 53.2 to 98.5 ± 34 μg/ml (P = 0.0001), 1,25-dihydroxyvitamin D from 103 ± 52 to 42 ± 4 pmol/l (P = 0.003) and 25-hydroxyvitamin D from 49.7 ± 29 to 22 ± 9.4 nmol/l (P = 0.0017), through their removal in effluent. After 7 days, DBP and 1,25-dihydroxyvitamin D were not significantly different from baseline, but 25-hydroxyvitamin D remained significantly lower after 7 days (26.4 ± 9.8 nmol/l, P = 0.02) and 28 days (30.8 ± 15.5 nmol/l, P = 0.048). Corrected calcium decreased from 2.23 ± 0.11 to 1.98 ± 0.08 mmol/l (P = 0.0007) immediately after five treatments. Plasma calcium was significantly associated with 1,25-dihydroxyvitamin D (r(2) = 0.79, P < 0.0001). CONCLUSION: Plasma exchange induced an acute reversible decrease in plasma 1,25-dihydroxyvitamin D, DBP, calcium and a sustained decrease in plasma 25-hydroxyvitamin D.
Authors: G A Rock; K H Shumak; N A Buskard; V S Blanchette; J G Kelton; R C Nair; R A Spasoff Journal: N Engl J Med Date: 1991-08-08 Impact factor: 91.245
Authors: Liya Yan; Inez Schoenmakers; Bo Zhou; Landing M Jarjou; Emily Smith; Shailja Nigdikar; Gail R Goldberg; Ann Prentice Journal: Bone Date: 2009-04-24 Impact factor: 4.398
Authors: Katrine Grau; Senthil K Vasan; Klaus Rostgaard; Walter Bialkowski; Rut Norda; Henrik Hjalgrim; Gustaf Edgren Journal: Transfusion Date: 2016-11-18 Impact factor: 3.157
Authors: Michelle R Denburg; Andrew N Hoofnagle; Samir Sayed; Jayanta Gupta; Ian H de Boer; Lawrence J Appel; Ramon Durazo-Arvizu; Krista Whitehead; Harold I Feldman; Mary B Leonard Journal: J Bone Miner Res Date: 2016-06 Impact factor: 6.741