Efficacy and Safety of Double Filtration Plasmapheresis and Single Plasma Exchange in Patients with Lupus Nephritis: A Single-Center, Real-World Retrospective Study

INTRODUCTION: Single plasma exchange (SPE) and double filtration plasmapheresis (DFPP) are commonly used in clinical practice. However, there have not been clear recommendations on the selection of SPE or DFPP for treating lupus nephritis (LN) in existing therapeutic PE guidelines. Therefore, this study aimed to evaluate the efficacy and safety of DFPP and SPE in patients with LN and to analyze the risk factors associated with ineffective DFPP and SPE treatment. METHODS: In this single-center, real-world retrospective study, the safety and efficacy of therapy with SPE or DFPP were assessed in 67 patients with LN. Changes in laboratory test indicators and clinical parameters before and after treatment were compared, and the occurrence of adverse events (AEs) was observed in these patients. RESULTS: Twenty-four patients were treated with DFPP and 43 patients with SPE. Both DFPP and SPE showed a significant treatment response. The effective rate of DFPP was higher than that of SPE (p < 0.05), but the difference was not statistically significant. In both groups, platelet count, potassium, chloride, activated partial thromboplastin time, and fibrinogen were significantly lower at baseline, and sodium was significantly higher at baseline (p < 0.05). The incidence of AEs in the DFPP group was lower than in the SPE group. The amount of plasma used in the DFPP group was significantly less than that in the SPE group during hospitalization. The economic cost of hospitalization or the remission rate did not differ significantly between the two groups. Length of hospital stay and serum creatinine were identified as risk factors for ineffective short-term PE in the treatment of LN. CONCLUSION: Both DFPP and SPE were effective and safe procedures for treating LN. However, DFPP does not depend on plasma and may reduce the incidence of adverse reactions; therefore, it should be promoted.