Introduction:
Therapeutic plasma exchange (TPE) is an apheresis technique involving extracorporeal removal of plasma from other components of blood, discarding and replacing plasma with physiological fluids. The ideal characteristics of a substance to be removed by TPE include large molecular weight, distribution in the intravascular space, and prolonged half-life, among others. TPE, by removing these pathogenic substances (autoantibodies, immune complexes), provides a therapeutic window for drugs to act, and has been used in many disorders either alone or in combination with other therapies.
TPE has been applied as a therapeutic measure in a number renal conditions including Anti-GBM disease (Anti-glomerular basement membrane disease), ANCA (Anti-neutrophil cytoplasmic antibody) vasculitis, TMA (thrombotic microangiopathy), ABMR (antibody-mediated rejection) in renal allograft recipients to name a few.
In this study, we report data from our center on the overall utility and performance of TPE in renal diseases.
Methods:
This is a retrospective observational study of patients treated with TPE during a period of one year (September, 2023 – August, 2024) in the department of nephrology. We analyzed medical records focusing on history, demographic data (sex, age), biochemical parameters, underlying disease, number of TPE sessions received, complications, patient mortality, degree of renal impairment and evolution of renal function.
Results:
The total number of patients included in our study was 32, of which 14 (43.75%) were male and 18 (56.25%) were female. The age range was 7-65 years. The total number of TPE sessions done were 211 and the indications were as follows: Anti-GBM disease-5, ANCA vasculitis-13, dual antibody positive (ANCA + Anti-GBM)-4, TMA-2 and ABMR-8. The overall mortality was 7 (21.86%), 2 deaths in the Anti-GBM group, 3 in ANCA group, 1 in dual positive group, 1 in ABMR group. Hemodialysis was required in 17 patients (53.13%) at presentation: Anti-GBM disease-3, ANCA vasculitis-6, dual positive-3, TMA-1, ABMR-4. At the end of treatment course, 9 patients (28.13%) remained on dialysis: 2 Anti-GBM, 3 ANCA, 1 dual positive,2 ABMR and 1 TMA patient. The major procedural complications were: 1 case of catheter-related blood stream infection (CRBSI), 1 case of gastrointestinal bleeding, 2 cases of mild-moderate allergic reactions (urticaria, fever, rigor).
Conclusions:
In our study, the most common indication for TPE was ANCA vasculitis (40.62%) while highest mortality was in Anti-GBM disease (40%). Among 25 patients who survived, 14 patients (56%) had significant improvement in renal function.
TPE is a valuable life-saving therapeutic intervention in certain renal disorders in conjunction with additional immunosuppression, when applied in a timely manner. But the clinical response is not always predictable solely based on successful removal of a target substance. Our study provides useful information for clinical practice and has also led us to reflect on future strategies to optimize outcome in our patients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.