Therapeutic plasma exchange added to CRRT combined with hemoperfusion in wasp sting-associated AKI: A multicenter...

To evaluate whether adding therapeutic plasma exchange (PE) to continuous renal replacement therapy plus hemoperfusion (CRRT + HP) could improve renal recovery with wasp sting-associated acute kidney injury (AKI).

We conducted a multicenter retrospective cohort study in three tertiary hospitals in the Qinling region of China (July 2015-December 2024). Patients received either CRRT + HP or CRRT + HP + PE within a 72-h exposure window. The primary endpoint was renal recovery, which was analyzed in a competing-risk framework with death as the competing event. Cumulative incidence of renal recovery were compared using Gray's test, and fine-Gray models estimated subdistribution hazard ratios (sHR). Longitudinal changes in key laboratory variables and SOFA scores were assessed with linear mixed-effects models.

Among 176 eligible patients (CRRT + HP, n = 103; CRRT + HP + PE, n = 73), baseline severity was higher in the PE group before matching but was well balanced after propensity score matching. In the matched cohort, the CRRT + HP+PE group had a higher 30 days cumulative incidence of renal recovery than CRRT + HP (54.2% vs 32.2%). Overall renal recovery CIF curves favored CRRT + HP+PE (Gray's test, χ² = 6.277, p = 0.0122). In univariable fine-Gray analysis, PE was associated with increased renal recovery (sHR = 1.56, 95% CI 1.07-2.27; p = 0.021), and the association remained significant after multivariable adjustment (sHR 3.97, 95% CI 1.59-10.08; p < 0.001). 90-day mortality was numerically lower with PE but not statistically significant. Serum creatinine, total bilirubin, and SOFA score trajectories were improved faster in the CRRT + HP + PE group.

For patients with AKI caused by wasp stings, the addition of PE to CRRT + HP can improve early renal recovery and yield more favorable laboratory trajectories.