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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
Language English Country United States
Document type Journal Article, Randomized Controlled Trial, Multicenter Study
NLK
Freely Accessible Science Journals
from 1972
Open Access Digital Library
from 1972-01-01
- MeSH
- Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis * physiopathology therapy drug therapy complications immunology diagnosis MeSH
- Adult MeSH
- Glomerulonephritis * physiopathology immunology therapy blood MeSH
- Glucocorticoids * therapeutic use administration & dosage MeSH
- Glomerular Filtration Rate * MeSH
- Kidney * physiopathology drug effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Recovery of Function MeSH
- Aged MeSH
- Plasma Exchange * MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Randomized Controlled Trial 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
References provided by 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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