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The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial
B. Odler, R. Riedl, D. Geetha, WM. Szpirt, C. Hawley, L. Uchida, ZS. Wallace, G. Walters, E. Muso, V. Tesar, CD. Pusey, MA. Little, PA. Merkel, M. Walsh, DRW. Jayne, A. Kronbichler, PEXIVAS Investigators
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, randomizované kontrolované studie, multicentrická studie
NLK
Freely Accessible Science Journals
od 1972
Open Access Digital Library
od 1972-01-01
- MeSH
- ANCA-asociované vaskulitidy * patofyziologie terapie farmakoterapie komplikace imunologie diagnóza MeSH
- dospělí MeSH
- glomerulonefritida * patofyziologie imunologie terapie krev MeSH
- glukokortikoidy * terapeutické užití aplikace a dávkování MeSH
- hodnoty glomerulární filtrace * MeSH
- ledviny * patofyziologie účinky léků MeSH
- lidé středního věku MeSH
- lidé MeSH
- obnova funkce MeSH
- senioři MeSH
- výměna plazmy * MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
Therapeutic plasma exchange (PLEX) is an adjunctive treatment for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and kidney involvement. Little is known about the effect of PLEX on early changes in kidney function. This post-hoc analysis of the PEXIVAS trial investigated the effects of PLEX on changes in kidney function within 12 months. PEXIVAS was a randomized controlled trial recruiting 691 patients with ANCA-associated glomerulonephritis, of whom 349 underwent PLEX and 342 received no-PLEX. The primary outcomes of this post hoc study of PEXIVAS were change in estimated glomerular filtration rate (eGFR) from baseline and recovery of kidney function (defined as eGFR increase of 15ml/min/1.73m2 or more). Baseline eGFR was 21.7 ± 20.3 and 20.6 ± 18.7 ml/min/1.73m2 in the PLEX and no-PLEX groups, respectively. Mean improvements in eGFR at weeks two, four, and eight after initiation of therapy were greater for the PLEX vs. the no-PLEX groups. The greatest significant difference in recovery of kidney function in the PLEX compared to the no-PLEX groups was at week four (relative risk (RR): 1.41; 95% confidence interval:1.09-1.82). Increased eGFR or recovery of kidney function at week four were significantly associated with lower risk for end-stage kidney disease at week 52 (RR: 0.96: 0.95-0.97, and RR: 0.29: 0.16-0.52; respectively). Neither changes in eGFR nor recovery of kidney function differed by reduced- compared to standard-dose glucocorticoid group. Overall, our study indicates that PLEX improves early kidney function in patients with ANCA-associated glomerulonephritis.
Department of Immunology and Inflammation Imperial College London London UK
Department of Medicine McMaster University Hamilton Ontario Canada
Department of Medicine University of Cambridge Cambridge UK
Department of Nephrology Rigshospitalet University of Copenhagen Copenhagen Denmark
Department of Renal Medicine Canberra Hospital Canberra Australian Capital Territory Australia
Division of Nephrology Department of Internal Medicine Medical University of Graz Graz Austria
Division of Nephrology Johns Hopkins University Baltimore Maryland USA
Trinity Kidney Centre Trinity Translational Medicine Institute Trinity College Dublin Dublin Ireland
Citace poskytuje Crossref.org
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- $a Therapeutic plasma exchange (PLEX) is an adjunctive treatment for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and kidney involvement. Little is known about the effect of PLEX on early changes in kidney function. This post-hoc analysis of the PEXIVAS trial investigated the effects of PLEX on changes in kidney function within 12 months. PEXIVAS was a randomized controlled trial recruiting 691 patients with ANCA-associated glomerulonephritis, of whom 349 underwent PLEX and 342 received no-PLEX. The primary outcomes of this post hoc study of PEXIVAS were change in estimated glomerular filtration rate (eGFR) from baseline and recovery of kidney function (defined as eGFR increase of 15ml/min/1.73m2 or more). Baseline eGFR was 21.7 ± 20.3 and 20.6 ± 18.7 ml/min/1.73m2 in the PLEX and no-PLEX groups, respectively. Mean improvements in eGFR at weeks two, four, and eight after initiation of therapy were greater for the PLEX vs. the no-PLEX groups. The greatest significant difference in recovery of kidney function in the PLEX compared to the no-PLEX groups was at week four (relative risk (RR): 1.41; 95% confidence interval:1.09-1.82). Increased eGFR or recovery of kidney function at week four were significantly associated with lower risk for end-stage kidney disease at week 52 (RR: 0.96: 0.95-0.97, and RR: 0.29: 0.16-0.52; respectively). Neither changes in eGFR nor recovery of kidney function differed by reduced- compared to standard-dose glucocorticoid group. Overall, our study indicates that PLEX improves early kidney function in patients with ANCA-associated glomerulonephritis.
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