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 Internal Medicine 4 Nephrology and Hypertension Medical University of Innsbruck Innsbruck Austria

Department of Medicine McMaster University Hamilton Ontario Canada; Population Health Research Institute Hamilton Health Sciences McMaster University Hamilton Ontario Canada

Department of Medicine University of Cambridge Cambridge UK

Department of Nephrology 1st Faculty of Medicine and General University Hospital Charles University Prague Czech Republic

Department of Nephrology and Dialysis Medical Research Institute Kitano Hospital PIIF Tazuke Kofukai Osaka Japan

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; Department of Medicine University of Cambridge Cambridge UK

Division of Nephrology Johns Hopkins University Baltimore Maryland USA

Division of Rheumatology Allergy and Immunology Mongan Institute Massachusetts General Hospital Harvard Medical School Boston Massachusetts USA

Division of Rheumatology Department of Medicine University of Pennsylvania Philadelphia Pennsylvania USA; Division of Epidemiology Department of Biostatistics Epidemiology and Informatics University of Pennsylvania Philadelphia Pennsylvania USA

Institute for Medical Informatics Statistics and Documentation Medical University of Graz Graz Austria

The Australasian Kidney Trials Network Centre for Health Services Research University of Queensland Brisbane Australia

Trinity Kidney Centre Trinity Translational Medicine Institute Trinity College Dublin Dublin Ireland

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