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October 2, 1981

Plasmapheresis, Infection, and Renal Disease

JAMA. 1981;246(14):1545. doi:10.1001/jama.1981.03320140033011

To the Editor.—  I read the report by Wing and associates (1980;244:2423) of their experience with patients receiving plasmapheresis for acute renal disease. We have recently completed a prospective study of the infective complications in 75 patients who required high-dose immunosuppression and intensive plasmapheresis (unpublished data), and our results are somewhat at variance with those described by Wing et al.Almost all of our patients had active nephritis, underlying antiglomerular basement membrane disease, polyarteritis, Wegener's granulomatosis, or systemic lupus erythematosus. They received a regimen of high-dose corticosteroids, cyclophosphamide, and azathioprine; 50 patients were treated additionally with plasmapheresis in the amount of 4 L/day (mean, 13 days; range, two to 45 days).There was no correlation between the incidence of infection and the duration of plasmapheresis in the group as a whole (r=.34). A further analysis was performed in 23 patients with major infective complications (serious opportunist infections and death owing