Objectives: To evaluate whether adding therapeutic plasma exchange (PE) to continuous renal replacement therapy plus hemoperfusion (CRRT + HP) could improve renal recovery with wasp sting–associated acute kidney injury (AKI). Methods: We conducted a multicenter retrospective cohort study in three tertiary hospitals in the Qinling region of China (July 2015–December 2024). Patients received either CRRT + HP or CRRT + HP + PE within a 72-h exposure window. The primary endpoint was renal recovery, which was analyzed in a competing-risk framework with death as the competing event. Cumulative incidence of renal recovery were compared using Gray’s test, and fine–Gray models estimated subdistribution hazard ratios (sHR). Longitudinal changes in key laboratory variables and SOFA scores were assessed with linear mixed-effects models. Results: Among 176 eligible patients (CRRT + HP, n = 103; CRRT + HP + PE, n = 73), baseline severity was higher in the PE group before matching but was well balanced after propensity score matching. In the matched cohort, the CRRT + HP+PE group had a higher 30 days cumulative incidence of renal recovery than CRRT + HP (54.2% vs 32.2%). Overall renal recovery CIF curves favored CRRT + HP+PE (Gray’s test, χ 2 = 6.277, p = 0.0122). In univariable fine–Gray analysis, PE was associated with increased renal recovery (sHR = 1.56, 95% CI 1.07–2.27; p = 0.021), and the association remained significant after multivariable adjustment (sHR 3.97, 95% CI 1.59–10.08; p < 0.001). 90-day mortality was numerically lower with PE but not statistically significant. Serum creatinine, total bilirubin, and SOFA score trajectories were improved faster in the CRRT + HP + PE group. Conclusions: For patients with AKI caused by wasp stings, the addition of PE to CRRT + HP can improve early renal recovery and yield more favorable laboratory trajectories.
Li et al. (Fri,) studied this question.
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