Supplementary Material for: Feasibility, efficacy and safety of peripheral venous access for chronic double-filtration plasmapheresis with regional citrate anticoagulation

Introduction: Peripheral venous access (PVA) is recommended as a first-line vascular approach for therapeutic plasmapheresis with centrifugation methods but not filtration, which usually requires high blood flow. We evaluated the feasibility, efficacy and safety of double-filtration plasmapheresis (DFPP) with PVA, using ultrasound guidance and regional citrate anticoagulation (RCA) i.e. PVA-RCA-DFPP in patients undergoing chronic DFPP. Secondly, we assessed the number of central venous catheters (CVCs) avoided. Methods: A single-center retrospective study evaluated 22 adult patients on chronic DFPP to perform PVA-RCA-DFPP. They were classified into 3 groups: successful (i.e. completion of sessions with PVA), primary failure (i.e. no sessions completed), secondary failure (i.e. ≥ 1 session with PVA completed but secondary return with CVC or arteriovenous fistula (AVF)). Results: Among the 22 patients included (64% men), 7 patients (32%) were classified as primary failures (2 patient refusals, 5 inadequate PVAs), 1 patient (5%) as a secondary failure (due to uncomfortable venipunctures), and 14 patients (64%) as successful. In the successful group including 12 patients treated for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) and 2 patients for Familial Hypercholesterolemia (FH) (2 patients), 116 sessions were performed, with a median treated plasma volume of 4.3L [IQR 3.6-4.6] (45 ml/kg) for a median duration of 134 minutes [IQR 122-144], and a median blood flow of 94 ml/min IQR [87-103]. For the CIDP group, 90 % of sessions achieved a plasma volume > 1 TPV and for the FH group 91% of sessions achieved an LDLc reduction > 60%. Eleven sessions out of 116 (9%) were interrupted, mostly due to PVA dysfunction (5/11) and circuit clotting (4/11). Session interruptions decreased significantly between each patient’s first and following sessions (29% to 7%, p=0.009). Conclusion: Chronic PVA-RCA-DFPP can be performed safely and efficiently, avoiding the use of CVCs.