Benefits and limitations of plasmapheresis in renal diseases: an evidence-based approach

Abstract

In use for over 50 years, the rationale for plasmapheresis remains based largely on case series and retrospective studies. Recently, results from several randomized controlled trials, meta-analyses, and prospective studies have shown plasmapheresis may be of benefit in various renal diseases, and have provided insights into more rational use of this therapy. A multicenter trial by the European Vasculitis Study Group has shown it is the preferred additional form of therapy for patients with anti-neutrophil cytoplasmic antibody-associated glomerulonephritis and severe renal failure. A recent study conducted at Mayo Clinic also found it effective at reversing renal failure from myeloma-related cast nephropathy if serum free light chain levels were reduced by at least 50%. In addition, a Cochrane review has analyzed the available evidence for its use in thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. The objective of this article is to review recent and past evidence and, thereby, the current indications for treatment in renal disease.

Combination hemodialysis and centrifugal therapeutic plasma exchange: 18 years of Canadian experience

“…Official guidelines are published and updated regularly to guide clinicians with regards to initiation, continuation, and discontinuation of TPE . There is a specific group of patients with specific disease entities which require both TPE and HD during the course of treatment, thereby making simultaneous treatment an attractive option.…”

Journal of Artificial Organs 2011: the year in review

“…Recently, results from several randomized controlled trials (RCTs), meta-analyses, and prospective studies have shown plasmapheresis may be of benefit in a variety of renal diseases, and have provided some insight into more rational use of this therapy, although many of the guidelines are still not based on results from RCTs [51].…”

Therapeutic Plasma Exchange in Pediatric Kidney Disease: 23-year Experience at the Severance Children’s Hospital in Korea

“…Therapeutic plasma exchange (TPE) is a treatment modality to remove cir culating pathologic substances from the plasma and replace them with a sub stitution fluid (e.g., albumin or plasma) 1,2) . TPE has been applied in various dis eases such as neurological diseases (e.g., myasthenia gravis, GuillainBarré syndrome), hematological disorders (e.g., thrombotic thrombocytopenic pur pura, hemolytic uremic syndrome), metabolic disorders (e.g., inborn errors of metabolism, homozygous familial hypercholesterolemia), and kidney dis eases (e.g., the renal transplant candidate, antibody mediated renal allograft rejection, recurrent focal segmental glomerulosclerosis (FSGS) after renal transplantation, antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibodyassociated rapidly progres sing glomerulonephritis, and atypical hemolytic uremic syndrome (aHUS)) 3) .…”