Indications and recent evidence for apheresis in children and adults with kidney diseases: a comprehensive review.

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal Pub Date : 2025-09-10 eCollection Date: 2025-10-01 DOI:10.1093/ckj/sfaf282

Rupesh Raina, Eugene Yu-Hin Chan, Jieji Hu, Pujan Moradiya, Bryce Pember, Priyanka Khandelwal, Ruchi Mahajan, Ali Düzova, Kinnari Vala, Vivekanand Jha, Olivia Boyer, Sidharth Sethi, Pietro Canetta

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引用次数: 0

Abstract

Introduction: Plasmapheresis has been a therapeutic option in kidney diseases to eliminate disease-causing autoantibodies, circulating factors, and abnormal components involved in complement pathways. We aim to systematically review the effectiveness and adverse events associated with plasmapheresis and related apheresis therapies in treating kidney diseases in paediatric and adult populations.

Methods: We searched databases including EMBASE, CINAHL, PubMed, and Cochrane Central for studies from 2010 to October 2023. The search terms included terms related to glomerulonephritis treated with plasmapheresis. Outcomes included the patient's length of hospital stay, mortality, development of kidney failure, associated comorbidities, and adverse events. Risk of bias was assessed using the Newcastle-Ottawa Scale, and meta-analyses were performed to calculate pooled adverse event rates.

Results: A total of 33 studies with 1363 participants were included. The pooled proportion of kidney failure was 26.36% (95% CI 17.38%-36.47%), and the rate of dialysis requirement was 30.43% (95% CI 14.80%-48.82%). The mortality rate was 10.86% (95% CI 9.12%-12.81%). Adverse events were reported in 31.03% (95% CI 12.78%-53.05%) of cases. Heterogeneity was significant for most outcomes. We also performed a literature review due to a lack of adequate studies regarding the use of plasmapheresis in lupus nephritis, multiple myeloma, and atypical haemolytic uremic syndrome, as well as the use of low-density lipoprotein apheresis in kidney diseases.

Discussion: Plasmapheresis has demonstrated remission in patients with kidney diseases, particularly in those with ANCA-associated vasculitis and FSGS. Based on the results of our systematic review, we discuss the use of plasmapheresis for treating glomerular diseases, atypical haemolytic uremic syndrome, other kidney diseases, and the usage of low-density lipoprotein apheresis. Further research is needed to improve patient outcomes and reduce complications, especially in paediatric populations.

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儿童和成人肾脏疾病的采血适应症和最新证据：全面回顾。

血浆置换术一直是肾脏疾病的一种治疗选择，用于消除引起疾病的自身抗体、循环因子和补体途径中涉及的异常成分。我们的目的是系统地回顾血浆分离术和相关血浆分离疗法治疗儿科和成人肾脏疾病的有效性和不良事件。方法：检索EMBASE、CINAHL、PubMed和Cochrane Central等数据库，检索2010年至2023年10月的研究。搜索词包括与血浆置换治疗肾小球肾炎相关的词。结果包括患者住院时间、死亡率、肾功能衰竭的发展、相关合并症和不良事件。使用纽卡斯尔-渥太华量表评估偏倚风险，并进行荟萃分析以计算汇总不良事件发生率。结果：共纳入33项研究，1363名受试者。合并肾衰竭的比例为26.36% (95% CI 17.38%-36.47%)，需要透析的比例为30.43% （95% CI 14.80%-48.82%）。死亡率为10.86% （95% CI 9.12% ~ 12.81%）。不良事件发生率为31.03% （95% CI 12.78% ~ 53.05%）。异质性在大多数结果中是显著的。由于缺乏充分的研究，我们也进行了文献回顾，关于血浆分离术在狼疮肾炎、多发性骨髓瘤和非典型溶血性尿毒症综合征中的应用，以及低密度脂蛋白分离术在肾脏疾病中的应用。讨论：血浆置换术已证实可缓解肾脏疾病患者，特别是与anca相关的血管炎和FSGS患者。基于我们系统综述的结果，我们讨论血浆分离术在肾小球疾病、非典型溶血性尿毒症综合征、其他肾脏疾病中的应用，以及低密度脂蛋白分离术的应用。需要进一步研究以改善患者预后并减少并发症，特别是在儿科人群中。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Kidney Journal Medicine-Transplantation

CiteScore

6.70

自引率

10.90%

发文量

242

审稿时长

8 weeks

期刊介绍： About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.