Efficacy of plasma exchange in severe crescentic IgA nephropathy: A multicentered, cohort study.
- Author:
Zi WANG
1
,
2
,
3
,
4
;
Jun Jun ZHANG
5
;
Li ZUO
6
;
Yue WANG
7
;
Wen Ge LI
8
;
Hong CHENG
9
;
Guang Yan CAI
10
;
Hua Ying PEI
11
;
Li Hua WANG
12
;
Xu Jie ZHOU
1
,
2
,
3
,
4
;
Su Fang SHI
1
,
2
,
3
,
4
;
Li Jun LIU
1
,
2
,
3
,
4
;
Ji Cheng LV
1
,
2
,
3
,
4
;
Hong ZHANG
1
,
2
,
3
,
4
Author Information
1. Renal Division, Peking University First Hospital
2. Institute of Nephrology, Peking University
3. Key Laboratory of Renal Disease, Ministry of Health of China
4. 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.
5. Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
6. Department of Nephrology, Peking University People's Hospital, Beijing 100044, China.
7. Department of Nephrology, Peking University Third Hospital, Beijing 100191, China.
8. Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
9. Division of Nephrology, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, China.
10. Department of Nephrology, Chinese PLA General Hospital, Beijing 100853, China.
11. Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China.
12. Renal Division, Shanxi Medical University Second Affiliated Hospital, Taiyuan 030001, China.
- Publication Type:Journal Article
- Keywords:
Crescentic glomerulonephritis;
Glomerulonephritis;
IgA nephropathy;
Plasma exchange therapy
- MeSH:
Cohort Studies;
Glomerulonephritis, IGA/pathology*;
Humans;
Kidney Failure, Chronic/therapy*;
Plasma Exchange;
Prognosis;
Retrospective Studies;
Steroids/therapeutic use*
- From:
Journal of Peking University(Health Sciences)
2022;54(5):1038-1046
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To evaluate the efficacy of plasma exchange therapy on crescentic IgA nephropathy (IgAN).
METHODS:A retrospective analysis was performed in a cohort of patients with crescentic IgAN from January 2012 to September 2020 at 9 sites across China. Clinical and pathological data, as well as therapeutic regimens, were collected. In order to minimize the effect of potential confounders in baseline characteristics, propensity score matching using a 1 ∶1 ratio nearest neighbor algorithm was performed between the adjunctive plasma exchange therapy group and the intensive immunosuppressive therapy group. The primary outcome was end-stage of kidney disease (ESKD). Kaplan-Meier method was used to compare the difference in renal survival between the two groups.
RESULTS:A total of 95 crescentic IgAN patients with acute kidney disease were included in this study, including 37 (38.9%) patients receiving adjunctive plasma exchange therapy, and 58 (61.1%) patients receiving intensive immunosuppressive therapy. In the whole cohort, the baseline eGFR was 12.77 (7.28, 21.29) mL/(min·1.73 m2), 24-hour urinary protein quantification was 5.9 (4.0, 8.9) g, and crescent percentage was 64.71% (54.55%, 73.68%). In the study, 23 patients in each group were matched after propensity score matching The median follow-up time was 7 (1, 26) months. As a whole, 29 patients (63.0%) reached ESKD, including 16 patients (69.6%) in the adjunctive plasma exchange therapy group and 13 (56.5%) patients in the intensive immunosuppressive therapy group.. There were no stastical difference between the two groups in terms of baseline eGFR [14.30 (9.31, 17.58) mL/(min·1.73 m2) vs. 11.45 (5.59, 20.79) mL/(min·1.73 m2)], 24-hour urinary protein (7.4±3.4) g vs. (6.6±3.8) g, crescent percentage 64.49%±13.23% vs. 66.41%±12.65% and the proportion of patients received steroid therapy[23 (100.0%) vs. 21 (91.3%)] (All P>0.05). Kaplan-Meier survival analysis demonstrated that there was no significant difference in renal survival rate between the two groups (Log-rank test, P=0.933).
CONCLUSION:The adjunctive plasma exchange therapy in addition to conventional intense immunosuppressive therapy did not additionally improve the prognosis of crescentic IgA nephropathy.
