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

Background Single plasma exchanges (SPE) and double filtration plasmapheresis (DFPP) are commonly used in clinical practice. However, there haven’t been clear recommendations on the selection of SPE or DFPP in treating lupus nephritis (LN) in existing Therapeutic plasma exchange（TPE） related guidelines. Therefore, we aimed to evaluate the efficacy and safety of DFPP and SPE in patients with LN, and analyze the risk factors of ineffective DFPP and SPE in the treatment of LN. Methods: In this single-center, real-world retrospective study, we assessed safety and efficacy of therapy with SPE or DFPP in 67 patients with LN. Changes of laboratory test indicators and statistical indicators before and after treatment were compared, and the occurrence of adverse events (AEs) was observed in these patients. Results： 24 patients were treated with DFPP and 43 patients with SPE. DFPP and SPE showed a comparatively 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, potassium, chloride, APTT, Fib were significantly lower at baseline, and sodium was significantly higher at baseline (P<0.05), and the difference was statistically significant. The incidence of AEs in DFPP group was lower than in SPE group. The amount of plasma used in DFPP group was significantly less than that in SPE group during hospitalization. Economic cost of hospitalization and remission rate were no significant difference between the two groups. Length of hospital stay and serum creatinine both were the risk factors of ineffective short-term plasma exchange（PE）in the treatment of LN. Conclusions: In summary, both DFPP and SPE were effective and safe procedures for treating LN. However, DFPP did not depend on plasma, and could reduce the incidence of adverse reactions, it should be promoted.