Systematic investigations of hemodynamic status during
double filtration plasmapheresis (
DFP) are rare in the literature. To investigate the hemodynamic effects of the vascular access chosen for
DFP, variations in blood pressure (BP) and pulse rate (PR) induced acutely by
DFP were prospectively analyzed in 46
myasthenia gravis (MG) patients a standard
DFP protocol with isovolumetric saline fluid replacement. BP and PR were monitored at 30-min intervals (baseline, M30, M60, M90, and M120) during the procedures. The patients 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 the baseline level. Symptomatic
hypotension was not observed in any of the 46 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 changes during
plasmapheresis also differed at M90 (103.4 vs. 94.5%, P < 0.001) 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 and resultant delay in volume replacement. In conclusion, the vascular access selected for
DFP plays a role in the pathogenesis of
plasmapheresis-related
hypotension. Controlling flow rates may help to prevent
hypotension.