Efficacy of Therapeutic Apheresis for Cryoglobulinemic Vasculitis Patients with Renal Involvement: A Systematic Review.

IF 2.2 3区医学 Q3 HEMATOLOGY

Blood Purification Pub Date : 2024-01-01 Epub Date: 2023-10-18 DOI:10.1159/000534102

Jing Miao, Pajaree Krisanapan, Supawit Tangpanithandee, Charat Thongprayoon, Wisit Cheungpasitporn

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引用次数: 0

Abstract

Introduction: Therapeutic apheresis (TA) is commonly used for cryoglobulinemic vasculitis (CV) patients, but its efficacy remains uncertain. This systematic review aimed to assess the efficacy of different TA modalities, such as plasma exchange (PE), plasmapheresis (PP), and cryofiltration (CF), in treating CV patients with renal involvement.

Methods: Literature search of MEDLINE, EMBASE, and Cochrane Databases was conducted up to December 2022. Studies that reported the outcomes of TA in adult CV patients with renal involvement were assessed. The protocol for this systematic review has been registered with PROSPERO (No. CRD42023417727). The quality of each study was evaluated by the investigators using the validated methodological index for non-randomized studies (minors) quality score.

Results: 154 patients who encountered 170 episodes of serious events necessitating TA were evaluated across 76 studies. Among them, 51% were males, with a mean age ranging from 49 to 58 years. The CV types included 15 type I, 97 type II, and 13 type III, while the remaining patients exhibited mixed (n = 17) or undetermined CV types (n = 12). Among the treatment modalities, PE, PP, and CF were performed in 85 (56%), 52 (34%), and 17 patients (11%), respectively, with no identical protocol for TA treatment. The overall response rate for TA was 78%, with response rates of 84%, 77%, and 75% observed in type I, II, and III patients respectively. Most patients received steroids, immunosuppressants, and treatment targeting the underlying causative disease. The overall long-term renal outcome rate was 77%, with type I, II, and III patients experiencing response rates of 89%, 76%, and 90%, respectively. The renal outcomes in patients receiving PE, PP, and CF were comparable, with rates of 78%, 76%, and 81%, respectively.

Conclusions: This study presents compelling evidence that combination of TA with other treatments, especially immunosuppressive therapy, is a successful strategy for effectively managing severe renal involvement in CV patients. Among the TA modalities studied, including PE, PP, and CF, all demonstrated efficacy, with PE being the most frequently employed approach.

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单采治疗肾受累的冷球蛋白血症血管炎患者的疗效：系统评价。

引言：治疗性单采（TA）通常用于冷球蛋白血症血管炎（CV）患者，但其疗效尚不确定。这项系统综述旨在评估不同TA模式，如血浆置换（PE）、血浆置换（PP）和冷冻过滤（CF），在治疗肾脏受累的CV患者中的疗效。方法：截至2022年12月，对MEDLINE、EMBASE和Cochrane数据库进行文献检索。对报告肾功能损害的成年CV患者TA结果的研究进行了评估。该系统审查的方案已在PROSPERO注册（编号CRD42023417727）。每项研究的质量由研究人员使用非随机研究（未成年人）质量评分的验证方法指数进行评估。结果：在76项研究中对154名患者进行了评估，他们遇到了170次需要TA的严重事件。其中，51%为男性，平均年龄在49至58岁之间。CV类型包括15种I型、97种II型和13种III型，而其余患者表现出混合型（n=17）或未确定的CV类型（n=12）。在治疗方式中，PE、PP和CF分别在85名（56%）、52名（34%）和17名（11%）患者中进行，TA治疗方案不相同。TA的总有效率为78%，在I型、II型和III型患者中观察到的有效率分别为84%、77%和75%。大多数患者接受了类固醇、免疫抑制剂和针对潜在病因的治疗。总的长期肾脏转归率为77%，I型、II型和III型患者的有效率分别为89%、76%和90%。接受PE、PP和CF治疗的患者的肾脏结果具有可比性，其发生率分别为78%、76%和81%。结论：本研究提供了令人信服的证据，证明TA与其他治疗，特别是免疫抑制治疗相结合，是有效管理CV患者严重肾脏受累的成功策略。在所研究的TA模式中，包括PE、PP和CF，均显示出疗效，PE是最常用的方法。

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

Blood Purification 医学-泌尿学与肾脏学

CiteScore

5.80

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Practical information on hemodialysis, hemofiltration, peritoneal dialysis and apheresis is featured in this journal. Recognizing the critical importance of equipment and procedures, particular emphasis has been placed on reports, drawn from a wide range of fields, describing technical advances and improvements in methodology. Papers reflect the search for cost-effective solutions which increase not only patient survival but also patient comfort and disease improvement through prevention or correction of undesirable effects. Advances in vascular access and blood anticoagulation, problems associated with exposure of blood to foreign surfaces and acute-care nephrology, including continuous therapies, also receive attention. Nephrologists, internists, intensivists and hospital staff involved in dialysis, apheresis and immunoadsorption for acute and chronic solid organ failure will find this journal useful and informative. ''Blood Purification'' also serves as a platform for multidisciplinary experiences involving nephrologists, cardiologists and critical care physicians in order to expand the level of interaction between different disciplines and specialities.