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[Efficacy of plasma exchange in severe crescentic IgA nephropathy: A multicentered, cohort study]

Z Wang1, J J Zhang2, L Zuo3

  • 1Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Research Units of Diagnosis and Treatment of lmmune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing 100191, China.

Beijing Da Xue Xue Bao. Yi Xue Ban = Journal of Peking University. Health Sciences
|October 14, 2022
PubMed

Insights

Plasma exchange therapy did not improve outcomes for patients with crescentic IgA nephropathy (IgAN). This study found no significant difference in renal survival between patients receiving plasma exchange and those on intensive immunosuppressive therapy alone.

Area of Science:

  • Nephrology
  • Immunology
  • Internal Medicine

Background:

  • Crescentic IgA nephropathy (IgAN) is a severe form of IgAN characterized by rapid kidney function decline.
  • Treatment strategies for crescentic IgAN aim to halt disease progression and preserve kidney function.
  • The role of plasma exchange therapy in addition to immunosuppression for crescentic IgAN remains controversial.

Purpose of the Study:

  • To evaluate the efficacy of adjunctive plasma exchange therapy compared to intensive immunosuppressive therapy alone in patients with crescentic IgA nephropathy.
  • To assess the impact of plasma exchange on renal survival and progression to end-stage kidney disease (ESKD).

Main Methods:

  • Retrospective analysis of 95 patients with crescentic IgAN from 9 Chinese centers (January 2012 - September 2020).
  • Propensity score matching (1:1 ratio) was used to compare patients receiving adjunctive plasma exchange therapy with those receiving intensive immunosuppressive therapy.
  • Primary outcome was end-stage kidney disease (ESKD); renal survival was analyzed using the Kaplan-Meier method.

Main Results:

  • After propensity score matching, 23 patients were in each group (plasma exchange vs. intensive immunosuppression).
  • No significant differences were observed in baseline characteristics including eGFR, proteinuria, crescent percentage, or steroid use between the groups.
  • Kaplan-Meier analysis showed no significant difference in renal survival rates between the two treatment groups (Log-rank test, P=0.933).

Conclusions:

  • Adjunctive plasma exchange therapy, when added to conventional intense immunosuppressive therapy, did not improve the prognosis for patients with crescentic IgA nephropathy.
  • Current evidence suggests that plasma exchange may not offer additional benefit over standard intensive immunosuppression for this condition.
Abstract

Keywords:
Crescentic glomerulonephritisGlomerulonephritisIgA nephropathyPlasma exchange therapy

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