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首页> 外文期刊>Blood purification >Double Filtration Plasmapheresis in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Kidney Dysfunction
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Double Filtration Plasmapheresis in the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis with Severe Kidney Dysfunction

机译：双滤膜治疗抗中性粒细胞细胞质抗体相关血管炎，严重肾功能障碍

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Background: Therapeutic plasma exchange (TPE) has been recommended by guidelines for the treatment of anti-neutrophil cytoplasmic antibodies-associated vasculitis (AAV) with severe kidney dysfunction. In recent years, some researchers have proposed that double-filtration plasmapheresis (DFPP) can also be used effectively in the treatment of these patients, but the difference between the 2 modalities?of plasmapheresis is not clear. Methods: In this retrospective?cohort study of AAV patients with serum creatinine ≥500 μmol/L from March 2013 to July 2018 who received TPE or DFPP treatment, we compared TPE and DFPP in terms of the changes of clinical parameters before and after plasmapheresis, the rates of adverse events during plasmapheresis, and kidney and patient survival during follow-up. Results: Forty-two AAV patients with kidney injury were included in this study. Twenty patients were treated with TPE and 22 patients were treated with DFPP. All patients were followed up for a median of 22 months. In each group, there were 10 deaths, and 6 patients developed end-stage kidney disease (ESKD). There were no significant differences between TPE and DFPP in terms of the changes of renal function or other laboratory results after treatment. During the plasmapheresis treatment, there was no significant difference in the rate of adverse events ( p = 0.67). During the follow-up, there was no difference between the groups regarding the level of serum creatinine for patients with kidney recovery. The hazard ratio (HR) for TPE compared to DFPP for the outcome of ESKD was 0.92 (95% CI 0.45–1.9; p = 0.79) and the HR for death was 1.11 (95% CI 0.45–2.76; p = 0.82). Conclusion: There were no differences in short-term effectiveness, safety, or long-term outcomes between the 2 modalities of plasmapheresis. Our study suggests that DFPP may be a choice of plasmapheresis for AAV patients with severe kidney injury especially in countries and regions with limited blood resources.
机译：背景：治疗等离子体交换（TPE）已经通过治疗抗中性粒细胞细胞质抗体相关的血管炎（AAV）具有严重的肾功能障碍的准则。近年来，一些研究人员提出了双滤膜血浆（DFPP）也可以有效地用于治疗这些患者，但2个模式之间的差异是血浆的差异尚不清楚。方法：在此回顾下，群体血清肌酐患者≥500μmol/ l的群组2013年3月至2018年7月，我们接受了TPE或DFPP治疗，我们在血浆前后临床参数的变化方面比较了TPE和DFPP，在随访期间血浆疫苗中的不良事件的速度和肾脏和患者存活率。结果：本研究纳入42例AAV患有肾损伤的AAV患者。用TPE治疗二十名患者，22例患者用DFPP治疗。所有患者都随访22个月的中位数。在每组中，有10例死亡，6例患者开发了终级肾病（ESKD）。在治疗后肾功能或其他实验室结果的变化方面，TPE和DFPP之间没有显着差异。在血浆接收治疗期间，不良事件的速率没有显着差异（p = 0.67）。在随访期间，肾脏恢复患者的血清肌酐水平之间没有差异。与ESKD结果的DFPP相比TPE的危险比（HR）为0.92（95％CI 0.45-1.9; p = 0.79），HR为1.11（95％CI 0.45-2.76; P = 0.82）。结论：血浆血浆2型模式之间的短期有效性，安全性或长期成果没有差异。我们的研究表明，DFPP可能是AAV患者患有严重肾损伤患者的血浆的选择，特别是在血资资源有限的国家和地区。

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