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Background <p>Therapy regimen of patients with biopsy-proven crescentic and mixed antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis with renal insufficiency is uncertain. Plasma exchange (PE) treatment remains controversial when the kidney is involved in ANCA-associated vasculitis.</p> Methods <p>Patients with crescentic and mixed classes of ANCA-associated glomerulonephritis and serum creatinine ≥ 250 µmol/L between January 2020 and July 2024 in our center were retrospectively screened. Patients who received PE in addition to standard induction therapy with glucocorticoid and cyclophosphamide (CTX) or mycophenolate mofetil (MMF) were divided into PE group and patients who received standard induction therapy were divided into non-PE group as controls. Primary endpoint was mortality and dialysis independence.</p> Results <p>A total of 61 patients with diagnosis of ANCA-associated glomerulonephritis confirmed by renal biopsy with serum creatinine ≥ 250µmol/L were included in this study. 30 patients received standard induction therapy, and 31 were treated with plasma exchange in addition to standard induction therapy. PE plus standard induction therapy showed initial benefit in patient short-term survival rates, mortality at 3 months which occurred in 3 of 31 patients (9.7%) in PE group and in 12 of 30 patients (40.0%) in non-PE group. Mortality at 12 months showed no significant difference in both groups. Addition of PE showed no benefit on dialysis independence during follow-up. Patient dialysis independence rates at 3 months, 12 months were 19 (61.3%) of 31, 18 of 31 (58.1%) in PE group and 14 (46.7%) of 30, 13 of (43.3%) 30 in non-PE group, respectively. Infection events were more common in PE group (incidence rate, 61.3%) than in non-PE group (30%).</p> Conclusions <p>PE plus standard induction therapy improved short-term survival at 3 months in patients with crescentic and mixed ANCA-associated glomerulonephritis, However, it did not improve the dialysis independence and the 12-month survival rate, and was associated with a higher risk of infection. This indicates that the clinical application of PE requires a balance between its early survival benefits and infection risks, and should be individualized for the patients who are most likely to benefit.</p> Clinical trial number <p>Not applicable</p>

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Efficacy and safety of plasma exchange for crescentic and mixed classes of ANCA-associated glomerulonephritis with renal insufficiency

  • 期刊论文

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  • 发表日期：

    2025年12月12日

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  • Zhuan’e Yao,
  • Pengbo Wang,
  • Yanting Gao,
  • Peng Zhang

摘要

Background

Therapy regimen of patients with biopsy-proven crescentic and mixed antineutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis with renal insufficiency is uncertain. Plasma exchange (PE) treatment remains controversial when the kidney is involved in ANCA-associated vasculitis.

Methods

Patients with crescentic and mixed classes of ANCA-associated glomerulonephritis and serum creatinine ≥ 250 µmol/L between January 2020 and July 2024 in our center were retrospectively screened. Patients who received PE in addition to standard induction therapy with glucocorticoid and cyclophosphamide (CTX) or mycophenolate mofetil (MMF) were divided into PE group and patients who received standard induction therapy were divided into non-PE group as controls. Primary endpoint was mortality and dialysis independence.

Results

A total of 61 patients with diagnosis of ANCA-associated glomerulonephritis confirmed by renal biopsy with serum creatinine ≥ 250µmol/L were included in this study. 30 patients received standard induction therapy, and 31 were treated with plasma exchange in addition to standard induction therapy. PE plus standard induction therapy showed initial benefit in patient short-term survival rates, mortality at 3 months which occurred in 3 of 31 patients (9.7%) in PE group and in 12 of 30 patients (40.0%) in non-PE group. Mortality at 12 months showed no significant difference in both groups. Addition of PE showed no benefit on dialysis independence during follow-up. Patient dialysis independence rates at 3 months, 12 months were 19 (61.3%) of 31, 18 of 31 (58.1%) in PE group and 14 (46.7%) of 30, 13 of (43.3%) 30 in non-PE group, respectively. Infection events were more common in PE group (incidence rate, 61.3%) than in non-PE group (30%).

Conclusions

PE plus standard induction therapy improved short-term survival at 3 months in patients with crescentic and mixed ANCA-associated glomerulonephritis, However, it did not improve the dialysis independence and the 12-month survival rate, and was associated with a higher risk of infection. This indicates that the clinical application of PE requires a balance between its early survival benefits and infection risks, and should be individualized for the patients who are most likely to benefit.

Clinical trial number

Not applicable