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Efficacy of plasma exchange in severe crescentic IgA nephropathy: A multicentered, cohort study
Received date: 2022-06-07
Online published: 2022-10-14
Supported by
the National Natural Science Foundation of China(81322009);the National Natural Science Foundation of China(81270795);the Clinical Characteristic Applied Research Fund of Capital(Z161100000516005)
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.
Zi WANG , Jun-jun ZHANG , Li ZUO , Yue WANG , Wen-ge LI , Hong CHENG , Guang-yan CAI , Hua-ying PEI , Li-hua WANG , Xu-jie ZHOU , Su-fang SHI , Li-jun LIU , Ji-cheng LV , Hong ZHANG . Efficacy of plasma exchange in severe crescentic IgA nephropathy: A multicentered, cohort study[J]. Journal of Peking University(Health Sciences), 2022 , 54(5) : 1038 -1046 . DOI: 10.19723/j.issn.1671-167X.2022.05.034
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