ArticleThe Journal of clinical endocrinology and metabolism2026
Therapeutic Plasma Exchange and Changes in Calcium, Phosphate, Parathyroid Hormone, and Fibroblast Growth Factor-23.
Article in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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7 authors.
Funding
Abstract
contextTherapeutic plasma exchange (TPE) removes plasma proteins and other unwanted substances, causing nonspecific alterations of plasma components. A previous study showed an approximately 70% reduction in vitamin D metabolites following a single TPE treatment, prompting further investigation into TPE's effects on vitamin D regulators and metabolites: calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor-23 (FGF-23).
objectiveThis study examined changes in plasma and effluent levels of total calcium, phosphate, PTH, and FGF-23 in individuals undergoing TPE.
methodsMeasurements were taken immediately before, immediately after, and at follow-up. Paired t tests compared the percentage changes in metabolites from pre- to post-TPE.
resultsStudy participants (N = 42) had a mean age of 55 ± 16 years, 28 (67%) were female, and 32 (76%) were White. TPE led to acute changes in calcium (-9%; 95% CI, -11% to -8%), phosphate (-14%; -18% to -11%), and FGF-23 (-12%; -18% to -6%) concentrations. In contrast, PTH levels increased (91%; 63%-119%) from baseline to post-TPE. While most metabolites returned to baseline by the follow-up visit (median 4 [interquartile range, 3-7] days), nearly 25% of patients experienced persistent asymptomatic hypocalcemia. This persistent calcium deficit was not fully corrected by continuous intravenous calcium gluconate infusions administered during the study, nor by the endogenously increased PTH levels.
conclusionThese 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.
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