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Kidney Week

Abstract: SA-PO895

Efficacy of Therapeutic Apheresis for Cryoglobulinemic Vasculitis Patients with Renal Involvement

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Miao, Jing, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Krisanapan, Pajaree, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Tangpanithandee, Supawit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Thongprayoon, Charat, Mayo Clinic Minnesota, Rochester, Minnesota, United States
  • Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background

The administration of therapeutic apheresis (TA) to eliminate excessive abnormal immunoglobulins in patients with cryoglobulinemic vasculitis (CV) is a frequently employed approach; however, its efficacy has not been firmly established. This systematic review aimed to evaluate the efficacy of various TA modalities such as plasma exchange (PE), plasmapheresis (PP), and cryofiltration (CF) in patients with renal involvement suffering from CV.

Methods

A literature search was conducted using MEDLINE, EMBASE and Cochrane Databases through December 2022. Studies that reported outcomes of TA in adult CV with renal involvement were assessed.

Results

A total of 154 patients from 76 studies (comprising 13 case series and 63 case reports) were evaluated, with 51% males and a mean age of 49 to 58 years. There were 15 type I, 97 type II, and 13 type III; the remaining patients were either mixed (n=17) or their CV type was undetermined (n=12). Hematologic malignancy and HCV were the common causes of type I (53%) and type II (27%), respectively. PE, PP and CF were performed in 85 (56%), 52 (34%), and 17 (11%) patients, respectively. The overall response rate for TA was 78%, with type I, II, and III patients experiencing response rates of 84%, 77%, and 75%, respectively. The overall response rates of PE and PP were similar (76% vs 73%), but lower than CF (100%). Most patients received steroids, immunosuppressants, and treatment targeting the causative disease during TA and follow-up period. The overall long-term renal outcome rate was 77%, with type I, II and III patients experiencing response rate of 89%, 76% and 90%, respectively. The renal outcome in patients receiving PE, PP and CF were similar (78%, 76% and 81%, respectively).

Conclusion

This systematic review demonstrates that incorporating TA in conjunction with other treatments, such as immunosuppressive therapy, is a successful strategy for managing severe renal involvement in CV patients. While PE, PP, and CF were all effective TA modalities, PE was the most commonly used approach.