PLASMAPHERESIS IN NEUROLOGICAL DISEASES PERFORMED BY NEPHROLOGISTS

Introduction: Plasmapheresis is a therapeutic modality in increasing use, employed to eliminate pathogenic elements responsible for a disease or to replace deficient factors. It is a part of nephrological activity that should be strengthened in clinical practice. The purpose of this study is to describe the outcomes of plasmapheresis procedures performed by nephrologists in neurological diseases.

Materials and Methods: A descriptive-retrospective study of neurological diseases treated with plasmapheresis by the Nephrology Department of our Hospital was conducted from January to May 2023. All sessions were carried out using the transmembrane filtration technique with Plasma FluxR and Multifiltrate Fresenius equipment. Demographic data, the underlying disease, prior treatments, procedural characteristics (anticoagulation, replacement fluid, removed plasma volume), complications, and the clinical response of patients were analyzed. Additionally, laboratory data were recorded at the beginning and at the end of plasmapheresis sessions (Hematocrit/Platelets /Creatinine/Calcium/Phosphorus). 

Results. A total of 5 plasmapheresis procedures were performed, comprising 26 sessions, every 48 hours. All procedures were for neurological diseases. Patient characteristics were as follows: mean age of 45±24 years, with 60% being female. Guillain-Barre Syndrome was the most frequently treated disease (60%), followed by autoimmune encephalitis (20%) and myasthenia gravis (20%). Only 1 patient (20%) was treated with corticosteroids prior to plasmapheresis. All sessions were conducted using the Multifiltrate Fresenius equipment and P2Dry filter. Albumin was used as the replacement fluid in 100% of the patients. The average removed plasma volume during procedures was 2,68+0,48 liters (calculated based on each patient's weight and hematocrit). Heparin was the anticoagulant used in 100% of cases. 80% of patients had a favorable neurological clinical outcome with no procedure-related complications. One patient (20%) had a poor neurological outcome requiring mechanical ventilation, but later improved. No patients experienced disease recurrence after discharge. There were no significant differences in hematocrit, platelets, calcium, phosphorus, and creatinine levels before and after treatment.

Conclusions: In our experience, plasmapheresis using the transmembrane filtration technique is a safe and well-tolerated therapy for patients with neurological diseases. All patients exhibited a favorable response, resulting in improved short-term survival. Nephrologists should promote the use of this technique and document the results to expand the level of evidence in clinical practice.