Therapeutic Plasma Exchange and Changes in Calcium, Phosphate, Parathyroid Hormone, and Fibroblast Growth Factor-23
Authors' conclusion
These findings underscore the need for improved care protocols and vigilant monitoring of mineral metabolism in TPE patients, especially those receiving long-term treatment. Further research is warranted to understand the enduring effects of TPE on mineral metabolism and develop strategies to prevent complications.
Study context
- Population
- Individuals undergoing therapeutic plasma exchange (TPE); mean age 55 ± 16 years, 28 (67%) female, 32 (76%) White
- Participants
- 42 individuals
- Exposure
- Before vs after TPE
- TPEn = 42
- Outcome
- Percentage changes in plasma total calcium, phosphate, PTH and FGF-23
- Follow-up
- Pre- to post-TPE
Methodological detailssingle group, paired pre/post measurements
- Single group
- Paired pre/post measurements
Main finding
As reported in the abstract
Acute % change from baseline to post-TPE · immediately after TPE
Calcium
−9%; 95% CI, −11% to −8%
Phosphate
−14%; −18% to −11%
FGF-23
−12%; −18% to −6%
Parathyroid hormone (PTH)
91%; 63%-119%
Observational data: associations, not effects.
Further findings
Return to baseline at follow-up · median 4 [IQR, 3-7] days
- Most metabolites returned to baseline by follow-up visit
Safety
Persistent asymptomatic hypocalcemia · follow-up (median 4 [IQR, 3-7] days)
- Patients with persistent asymptomatic hypocalcemia
- nearly 25%
- Not fully corrected by continuous IV calcium gluconate infusions nor by endogenously increased PTH
Original publication
Therapeutic Plasma Exchange and Changes in Calcium, Phosphate, Parathyroid Hormone, and Fibroblast Growth Factor-23. J Clin Endocrinol Metab. Published 15 July 2025. doi:10.
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