RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS AP HERESIS TREATMENT - A MAJORECONOMIC-CHALLENGE

Since 1983, 28 patients with a rapidly progressive glomerulonephritis were treated with apheresis. Seventeen patients had a primary glomerul onephritis, 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 p erformed with the filtration technique, using a single needle device a nd central venous catheter. Plasmafilters were reused since 1984. In 1 987, cascade filtration was introduced. The procedure was under perman ent medical control. Mean reuse rate was 6 time. Renal actuarial survi val 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 aph eresis procedure. The mean cost of filters and blood lines was 490 Fre nch 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 di alysis months. The amount saved was 12 MFF. The additive cost of ineff icient apheresis was 0.06 MFF. These data have to be considered on a 0 .5 M inhabitants population basis during a 10 year survey.