双重滤过血浆置换治疗抗中性粒细胞胞质抗体相关性血管炎伴严重肾功能不全。

Double Filtration Plasmapheresis in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Kidney Dysfunction.

机构信息

National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.

Division of Nephrology, Kidney Research Laboratory, West China Hospital of Sichuan University, Chengdu, China.

出版信息

Blood Purif. 2020;49(6):713-722. doi: 10.1159/000507615. Epub 2020 Apr 15.

DOI:10.1159/000507615

PMID:32294643

Abstract

BACKGROUND

Therapeutic plasma exchange (TPE) has been recommended by guidelines for the treatment of anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV) with severe kidney dysfunction. In recent years, some researchers have proposed that double-filtration plasmapheresis (DFPP) can also be used effectively in the treatment of these patients, but the difference between the 2 modalities of plasmapheresis is not clear.

METHODS

In this retrospective cohort study of AAV patients with serum creatinine ≥500 μmol/L from March 2013 to July 2018 who received TPE or DFPP treatment, we compared TPE and DFPP in terms of the changes of clinical parameters before and after plasmapheresis, the rates of adverse events during plasmapheresis, and kidney and patient survival during follow-up.

RESULTS

Forty-two AAV patients with kidney injury were included in this study. Twenty patients were treated with TPE and 22 patients were treated with DFPP. All patients were followed up for a median of 22 months. In each group, there were 10 deaths, and 6 patients developed end-stage kidney disease (ESKD). There were no significant differences between TPE and DFPP in terms of the changes of renal function or other laboratory results after treatment. During the plasmapheresis treatment, there was no significant difference in the rate of adverse events (p = 0.67). During the follow-up, there was no difference between the groups regarding the level of serum creatinine for patients with kidney recovery. The hazard ratio (HR) for TPE compared to DFPP for the outcome of ESKD was 0.92 (95% CI 0.45-1.9; p = 0.79) and the HR for death was 1.11 (95% CI 0.45-2.76; p = 0.82).

CONCLUSION

There were no differences in short-term effectiveness, safety, or long-term outcomes between the 2 modalities of plasmapheresis. Our study suggests that DFPP may be a choice of plasmapheresis for AAV patients with severe kidney injury especially in countries and regions with limited blood resources.

摘要

背景

治疗性血浆置换（TPE）已被指南推荐用于治疗伴有严重肾功能障碍的抗中性粒细胞胞浆抗体相关性血管炎（AAV）。近年来，一些研究人员提出，双重滤过血浆置换（DFPP）也可有效用于这些患者的治疗，但两种血浆置换方式之间的差异尚不清楚。

方法

本研究回顾性纳入了 2013 年 3 月至 2018 年 7 月期间血清肌酐≥500μmol/L 的 AAV 患者，这些患者接受了 TPE 或 DFPP 治疗，比较了两种血浆置换方式在血浆置换前后临床参数的变化、血浆置换期间不良反应的发生率，以及随访期间的肾脏和患者生存情况。

结果

本研究共纳入 42 例伴有肾损伤的 AAV 患者，其中 20 例患者接受 TPE 治疗，22 例患者接受 DFPP 治疗。所有患者的中位随访时间为 22 个月。每组各有 10 例死亡，6 例患者进展为终末期肾病（ESKD）。在肾功能或其他实验室结果治疗后的变化方面，TPE 和 DFPP 之间无显著差异。在血浆置换治疗期间，不良反应发生率无显著差异（p=0.67）。在随访期间，对于肾脏恢复的患者，两组之间血清肌酐水平无差异。与 DFPP 相比，TPE 发生 ESKD 的风险比（HR）为 0.92（95%CI 0.45-1.9；p=0.79），死亡的 HR 为 1.11（95%CI 0.45-2.76；p=0.82）。