Kincaid Brenna S, Kim Kiana, Waller Jennifer L, Baer Stephanie L, Bollag Wendy B, Bollag Roni J
Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Department of Family and Community Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Diseases. 2025 Aug 5;13(8):247. doi: 10.3390/diseases13080247.
: Thrombotic thrombocytopenic purpura (TTP) is a microangiopathic hemolytic anemia exhibiting 90% mortality without prompt treatment. The aim of this study was to investigate the association of therapeutic plasma exchange (TPE)-treated TTP in end-stage renal disease (ESRD) patients with mortality, demographics, and clinical comorbidities. We queried the United States Renal Data System for ESRD patients starting dialysis between 1 January 2005 and 31 December 2018, using International Classification of Diseases (ICD)-9 and ICD-10 codes for thrombotic microangiopathy, with a TPE procedure code entered within 7 days. : Cox proportional hazards models were used to assess mortality, adjusting for demographic and clinical factors. : Among 1,155,136 patients, increased age [adjusted odds ratio (OR) = 0.96, 95% confidence interval (CI): 0.94-0.96]; black race (OR = 0.67, CI: 0.51-0.89); and Hispanic ethnicity (OR = 0.43, CI: 0.28-0.66) were associated with a lower risk of TPE-treated TTP diagnosis, whereas female sex (OR = 1.59, CI: 1.25-2.02) and tobacco use (OR = 2.08, CI: 1.58-2.75) had a higher risk. A claim for TPE-treated TTP carried a lower risk of death (adjusted hazard ratio = 0.024, CI: 0.021-0.028). Female sex, black race, Hispanic ethnicity, and hypothyroidism were also associated with decreased all-cause mortality. : These findings suggest that ESRD patients with TPE-treated TTP are significantly protected from mortality compared with ESRD patients without this diagnosis.
血栓性血小板减少性紫癜（TTP）是一种微血管病性溶血性贫血，若不及时治疗，死亡率达90%。本研究旨在调查终末期肾病（ESRD）患者接受治疗性血浆置换（TPE）治疗的TTP与死亡率、人口统计学和临床合并症之间的关联。我们查询了美国肾脏数据系统中2005年1月1日至2018年12月31日开始透析的ESRD患者，使用国际疾病分类（ICD）-9和ICD-10编码诊断血栓性微血管病，并在7天内输入TPE程序代码。采用Cox比例风险模型评估死亡率，并对人口统计学和临床因素进行校正。在1155136例患者中，年龄增加[校正比值比（OR）=0.96，95%置信区间（CI）：0.94-0.96]；黑人种族（OR=0.67，CI：0.51-0.89）；西班牙裔（OR=0.43，CI：0.28-0.66）与接受TPE治疗的TTP诊断风险较低相关，而女性（OR=1.59，CI：1.25-2.02）和吸烟（OR=2.08，CI：1.58-2.75）风险较高。接受TPE治疗的TTP患者死亡风险较低（校正风险比=0.024，CI：0.021-0.028）。女性、黑人种族、西班牙裔和甲状腺功能减退也与全因死亡率降低相关。这些发现表明，与未诊断出TPE治疗的TTP的ESRD患者相比，接受TPE治疗的TTP的ESRD患者在死亡率方面得到了显著保护。
