[Rapidly progressive glomerulonephritis treated by apheresis. A major economic challenge].
Since 1983, 28 patients with a rapidly progressive glomerulonephritis were treated with apheresis. Seventeen patients had a primary glomerulonephritis, while 11 had a secondary form. Pathological pattern showed crescentic glomerulonephritis in all cases but one. In 23 cases of 28, renal survival was compromised within a few months. Apheresis were performed with the filtration technique, using a single needle device and central venous catheter. Plasmafilters were reused since 1984. In 1987, cascade filtration was introduced. The procedure was under permanent medical control. Mean reuse rate was 6 time. Renal actuarial survival curve showed a 60%, 42% and 21% survival rate at respectively 1, 2 and 5 years. Five deaths were noted. No death occurred during the apheresis procedure. The mean cost of filters and blood lines was 490 French francs (FF) per session; the mean cost of an haemodialysis session was 1900 FF. When the real survival time was compared to the expected renal failure without apheresis (assuming a linear progression of the disease), patients with a positive response to apheresis saved 488 dialysis months. The amount saved was 12 MFF. The additive cost of inefficient apheresis was 0.06 MFF. These data have to be considered on a 0.5 M inhabitants population basis during a 10 year survey.
Branger
B
B
Service de Médecine Interne C et de Néphrologie, CHU, Nîmes.
Zabadani
B
B
Vécina
F
F
Mayor
M M
MM
Fourcade
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001781:Blood Component Removal / Q000191:economics; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D015432:Glomerulonephritis, Membranoproliferative / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors
D003404:Creatinine
Glomérulonéphrites rapidement progressives traitées par aphérèse. Un enjeu économique majeur.