Indications and recent evidence for apheresis in children and adults with kidney diseases: a comprehensive review.

Introduction: Plasmapheresis has been a therapeutic option in kidney diseases to eliminate disease-causing autoantibodies, circulating factors, and abnormal components involved in complement pathways. We aim to systematically review the effectiveness and adverse events associated with plasmapheresis and related apheresis therapies in treating kidney diseases in paediatric and adult populations. Methods: We searched databases including EMBASE, CINAHL, PubMed, and Cochrane Central for studies from 2010 to October 2023. The search terms included terms related to glomerulonephritis treated with plasmapheresis. Outcomes included the patient's length of hospital stay, mortality, development of kidney failure, associated comorbidities, and adverse events. Risk of bias was assessed using the Newcastle-Ottawa Scale, and meta-analyses were performed to calculate pooled adverse event rates. Results: A total of 33 studies with 1363 participants were included. The pooled proportion of kidney failure was 26.36% (95% CI 17.38%-36.47%), and the rate of dialysis requirement was 30.43% (95% CI 14.80%-48.82%). The mortality rate was 10.86% (95% CI 9.12%-12.81%). Adverse events were reported in 31.03% (95% CI 12.78%-53.05%) of cases. Heterogeneity was significant for most outcomes. We also performed a literature review due to a lack of adequate studies regarding the use of plasmapheresis in lupus nephritis, multiple myeloma, and atypical haemolytic uremic syndrome, as well as the use of low-density lipoprotein apheresis in kidney diseases. Discussion: Plasmapheresis has demonstrated remission in patients with kidney diseases, particularly in those with ANCA-associated vasculitis and FSGS. Based on the results of our systematic review, we discuss the use of plasmapheresis for treating glomerular diseases, atypical haemolytic uremic syndrome, other kidney diseases, and the usage of low-density lipoprotein apheresis. Further research is needed to improve patient outcomes and reduce complications, especially in paediatric populations.