{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T08:01:42Z","timestamp":1764403302724,"version":"3.41.2"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Clinical Apheresis"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Therapeutic plasma exchange (TPE) is an effective treatment for several renal disorders, including renal transplant rejection. However, repeated plasma exchanges can result in various metabolic disturbances and complications. We present a 61\u2010year old male with a medical history of type 2 diabetes, hypertension, successfully treated multiple myeloma, and a post\u2010mortem kidney transplantation 7\u2009months prior to presentation. The patient was hospitalized with an antibody\u2010mediated transplant rejection for which treatment with methylprednisolone, TPE with a 40\u2009g\/L albumin solution as a replacement fluid, and intravenous immunoglobulins was initiated. After four TPE treatments, the patient developed gastrointestinal complaints and muscle weakness. Despite daily oral bicarbonate supplementation, laboratory tests revealed a hyperchloremic metabolic acidosis: bicarbonate 11.7\u2009mmol\/L, chloride 111\u2009mmol\/L, and sodium 138\u2009mmol\/L. Metabolic acidosis due to citrate accumulation was ruled out with a normal total\u2010to\u2010ionized calcium ratio. After treatment with intravenous bicarbonate supplementation, the symptoms disappeared. Analysis of the albumin solution showed a chloride concentration of 132\u2009mmol\/L. This is the first case that describes severe metabolic acidosis after multiple sessions of TPE with an albumin solution in a patient with impaired renal function. The hyperchloremic metabolic acidosis is the result of administration of large volumes of an albumin solution with high chloride concentrations. Special attention should be paid to the acid\u2013base balance during TPE in patients with impaired renal function. Future research should investigate the incidence of hyperchloremic metabolic acidosis during TPE in patients with impaired renal function.<\/jats:p>","DOI":"10.1002\/jca.22092","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T12:49:23Z","timestamp":1696596563000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hyperchloremic metabolic acidosis after plasma exchange in a patient with renal transplant rejection: A case report"],"prefix":"10.1002","volume":"39","author":[{"given":"S.S.A.","family":"Simon","sequence":"first","affiliation":[{"name":"Division of Nephrology Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"},{"name":"Microcirculation Research Program Amsterdam Cardiovascular Sciences  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.S.","family":"van Sandwijk","sequence":"additional","affiliation":[{"name":"Division of Nephrology Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"},{"name":"Dianet Dialysis Centre  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.H.G.","family":"Olde Engberink","sequence":"additional","affiliation":[{"name":"Division of Nephrology Amsterdam UMC, University of Amsterdam  Amsterdam The Netherlands"},{"name":"Microcirculation Research Program Amsterdam Cardiovascular Sciences  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_7_2_1","DOI":"10.1016\/s0749\u20100704(01)00010\u20100"},{"doi-asserted-by":"publisher","key":"e_1_2_7_3_1","DOI":"10.1111\/j.1744\u20109987.2009.00733.x"},{"doi-asserted-by":"publisher","key":"e_1_2_7_4_1","DOI":"10.1016\/j.transci.2014.08.018"},{"doi-asserted-by":"publisher","key":"e_1_2_7_5_1","DOI":"10.1111\/trf.13215"},{"doi-asserted-by":"publisher","key":"e_1_2_7_6_1","DOI":"10.1002\/jca.22019"},{"doi-asserted-by":"publisher","key":"e_1_2_7_7_1","DOI":"10.1002\/jca.21432"},{"doi-asserted-by":"publisher","key":"e_1_2_7_8_1","DOI":"10.1007\/s00467\u2010018\u20104008\u20101"},{"doi-asserted-by":"publisher","key":"e_1_2_7_9_1","DOI":"10.5049\/EBP.2021.19.2.29"},{"doi-asserted-by":"publisher","key":"e_1_2_7_10_1","DOI":"10.1016\/j.nefro.2016.04.001"},{"doi-asserted-by":"publisher","key":"e_1_2_7_11_1","DOI":"10.1097\/CCM.0000000000002955"}],"container-title":["Journal of Clinical Apheresis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jca.22092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T08:38:00Z","timestamp":1709195880000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jca.22092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,6]]},"references-count":10,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1002\/jca.22092"],"URL":"https:\/\/doi.org\/10.1002\/jca.22092","archive":["Portico"],"relation":{},"ISSN":["0733-2459","1098-1101"],"issn-type":[{"type":"print","value":"0733-2459"},{"type":"electronic","value":"1098-1101"}],"subject":[],"published":{"date-parts":[[2023,10,6]]},"assertion":[{"value":"2023-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-21","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e22092"}}