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. 2023 Dec;45(1):2176694.
doi: 10.1080/0886022X.2023.2176694.

Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

Jing Miao  1 , Pajaree Krisanapan  1   2   3 , Supawit Tangpanithandee  1 , Charat Thongprayoon  1 , Michael A Mao  4 , Wisit Cheungpasitporn  1
Affiliations

Efficacy of extracorporeal plasma therapy for adult native kidney patients with Primary FSGS: a Systematic review

Jing Miao et al. Ren Fail. 2023 Dec.

Abstract

Purpose: This study aimed to assess efficacy of extracorporeal plasma therapy (EPT), including plasmapheresis (PE), immunoadsorption (IA), low-density lipoprotein apheresis (LDL-A), and lymphocytapheresis (LCAP) for adult native kidney patients with primary focal segmental glomerulosclerosis (FSGS).

Methods: A literature search was conducted using MEDLINE, EMBASE and Cochrane Databases through August 2022. Studies that reported outcomes of EPT in adult native kidneys with primary FSGS were enrolled.

Results: 18 studies with 104 therapy-resistant or refractory primary native FSGS patients were identified. Overall EPT response rate was 56%, with long-term benefit of 46%. Of the 101 non-hemodialysis (HD) patients, 54% achieved remission, with 30% complete remission (CR) and 23% partial remission (PR). Of 31 patients with PE, response rate was 65%; CR and PR rates were 27% and 37% in 30 non-HD patients. Of 61 patients with LDL-A, the response rate was 54%; CR and PR rates were 41% and 3% in 29 non-HD patients. Of 10 patients with IA, response rate was 40%. Of 2 patients with LCAP, 1 achieved CR, and one developed renal failure. All 3 HD patients showed increase in urine output and gradual decrease in urine protein excretion following PE (n = 1) or LDL-A (n = 2). 2 of 3 HD patients ultimately discontinued dialysis.

Conclusion: EPT with immunosuppressive therapy showed benefit in some patients with refractory primary FSGS, and PE appeared to have a higher response rate.

Keywords: Extracorporeal plasma therapy; FSGS; focal segmental glomerulosclerosis; plasmapheresis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
PRISMA flow diagram for study selection.
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