Objective: To investigate temporal associations between plasma exchange, dialysis exposure, and PD diagnosis using a nationwide administrative database in Japan.

Background: Emerging evidence suggests that circulating pathogenic proteins may contribute to the development and propagation of Parkinson’s disease (PD). Therapeutic plasma exchange (PE), which removes circulating proteins, may theoretically influence disease risk. However, population-level evidence remains limited.

Method: We conducted a retrospective analysis of a Japanese administrative claims database including adults aged ≥60 years between April 2015 and October 2022. PD (ICD-10 G20), chronic kidney disease (N18), dialysis dependence (Z99.2), and plasma exchange procedures were identified. Sequence symmetry analysis (SSA) was used to evaluate temporal asymmetry between exposure to dialysis or plasma exchange and subsequent PD diagnosis. Dialysis was used as a negative control exposure. Adjusted sequence ratios (ASR) were calculated with correction for temporal trends.

Results: Among 6,833,165 individuals, PD prevalence was 2.94%. CKD was associated with a higher prevalence of PD (4.07%). SSA showed no significant temporal asymmetry between dialysis exposure and PD diagnosis (ASR 1.76, 95% CI 1.61–1.93). In contrast, plasma exchange demonstrated an asymmetric pattern with fewer PD diagnoses occurring after exposure (ASR 0.57, 95% CI 0.34–0.92).

Conclusion: In this large population-based study, plasma exchange showed a temporal pattern consistent with fewer PD diagnoses following exposure, whereas dialysis did not.

These findings generate the hypothesis that removal of circulating pathogenic factors may influence PD development. Prospective studies are required to determine whether plasma exchange or related extracorporeal therapies could modify PD risk.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/plasma-exchange-and-reduced-parkinsons-disease-diagnosis-a-nationwide-sequence-symmetry-analysis/