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Dialysis and plasmapheresis for schizophrenia: a systematic review

Published online by Cambridge University Press:  14 May 2020

Emily R. Cox Open the ORCID record for Emily R. Cox [Opens in a new window] ,
Katie F. M. Marwick ,
Robert W. Hunter ,
Josef Priller  and
Stephen M. Lawrie
Emily R. Cox*
Affiliation:
University of Edinburgh, Royal Edinburgh Hospital, Division, United Kingdom
Katie F. M. Marwick
Affiliation:
University of Edinburgh, Royal Edinburgh Hospital, Division, United Kingdom
Robert W. Hunter
Affiliation:
University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, United Kingdom Department of Renal Medicine, Royal Infirmary of Edinburgh, United Kingdom
Josef Priller
Affiliation:
Centre for Clinical Brain Sciences and UK Dementia Research Institute at University of Edinburgh, United Kingdom Department of Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité – Universitätsmedizin Berlin, BIH and DZNE, 10117Berlin, Germany
Stephen M. Lawrie
Affiliation:
University of Edinburgh, Royal Edinburgh Hospital, Division, United Kingdom
*
Author for correspondence: Emily R. Cox, E-mail: s1103513@ed.ac.uk
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Abstract

Increasing evidence suggests that circulating factors and immune dysfunction may contribute to the pathogenesis of schizophrenia. In particular, proinflammatory cytokines, complement and autoantibodies against CNS epitopes have recently been associated with psychosis. Related concepts in previous decades led to several clinical trials of dialysis and plasmapheresis as treatments for schizophrenia. These trials may have relevance for the current understanding of schizophrenia. We aimed to identify whether dialysis or plasmapheresis are beneficial interventions in schizophrenia. We conducted a systematic search in major electronic databases for high-quality studies (double-blinded randomised trials with sham controls) applying either haemodialysis or plasmapheresis as an intervention in patients with schizophrenia, published in English from the start of records until September 2018. We found nine studies meeting inclusion criteria, reporting on 105 patients in total who received either sham or active intervention. One out of eight studies reported a beneficial effect of haemodialysis on schizophrenia, one a detrimental effect and six no effect. The sole trial of plasmapheresis found it to be ineffective. Adverse events were reported in 23% of patients. Studies were at unclear or high risk of bias. It is unlikely that haemodialysis is a beneficial treatment in schizophrenia, although the studies were of small size and could not consider potential subgroups. Plasmapheresis was only addressed by one study and warrants further exploration as a treatment modality in schizophrenia.

Keywords

Blindeddialysisimmuneplasmapheresisrandomisedschizophreniasystematictrial
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 8 , June 2020 , pp. 1233 - 1240
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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Footnotes

*

These authors contributed equally.

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