Therapeutic apheresis in kidney diseases: an updated review

Besides conventional medical therapies, therapeutic apheresis has become an important adjunctive or alternative therapeutic option to immunosuppressive agents for primary or secondary kidney diseases and kidney transplantation. The available therapeutic apheresis techniques used in kidney diseases, including plasma exchange, double-filtration plasmapheresis, immunoadsorption, and low-density lipoprotein apheresis. Plasma exchange is still the leading extracorporeal therapy. Recently, growing evidence supports the potential benefits of double-filtration plasmapheresis and immunoadsorption for more specific and effective clearance of pathogenic antibodies with fewer side effects. However, more randomized controlled trials are still needed. Low-density lipoprotein apheresis is also an important supplementary therapy used in patients with recurrent focal segmental glomerulosclerosis. This review collects the latest evidence from recent studies, focuses on the specific advantages and disadvantages of these techniques, and compares the discrepancy among them to determine the optimal therapeutic regimens for certain kidney diseases.

Automated summary

Therapeutic apheresis, including techniques such as plasma exchange, double-filtration plasmapheresis, immunoadsorption, and low-density lipoprotein apheresis, has become an important treatment option for kidney diseases. While plasma exchange remains the leading therapy, there is growing evidence supporting the potential benefits of double-filtration plasmapheresis and immunoadsorption. More research, particularly randomized controlled trials, is needed. Additionally, low-density lipoprotein apheresis is an important supplementary therapy for certain kidney diseases. This review aims to compare and determine the optimal therapeutic regimens for specific kidney diseases.