The effects of plasma exchange and glucocorticoids on early kidney function among patients with ANCA-associated vasculitis in the PEXIVAS trial
Balazs Odler, Regina Riedl, Duvuru Geetha, Wladimir Szpirt, Carmel M. Hawley, Lisa Uchida, Zachary S. Wallace, Giles Walters, Eri Muso, Vladimı́r Tesař, Charles D. Pusey, Mark A. Little, Peter A. Merkel, Michael Walsh, David Jayne, Andreas Kronbichler, Kathy Paizis, Giles Walters, Meg Jardine, Caroline Milton, Abu Ibraham, Brian Siva, Michael Desmond, Vlado Perkovic, Jadadeesh Kurtkoti, Eswari Vilayur, Alan Cass, Shaun Summers, Fiona Brown, Jessica Ryan, Peter Kerr, Euan Noble, Grant Luxton, David W. Mudge, Carmel Hawley, David W. Johnson, Chen Au Peh, Randall J. Faull, Dwarakanathan Ranganathan, Lisa Jeffs, Kathy Nicholls, Peter Hughes, Bruce Cooper, Neil Boudville, Sharon Ford, Robyn Langham, Donna Reidlinger, AliciaMorrish, Sunil V. Badve, Elaine Pascoe, Peta-Anne Paul-Brent, Laura Robison, Andrea Valks, Daniel Blockmans, Liesbet Henckaerts, Ben Sprangers, Rita Suri, Soumeya Brachemi, William Clark, Amit Garg, Simon Carette, Christian Pagnoux, Heather Reich, David Barth, Michael Walsh, Nader Khalidi, Gerry Cox, Andrea Mazzetti, Diane Robins, Ron Wald, Jeffrey Perl, Katerina Pavenski, Niki Dacouris, Adeera Levin, Michael Copland, Todd Fairhead, Neesh Pannu, Muhammad Uwais Qarni, Syed Habib, Louis Girard, Braden Manns, Vladimir Tesar, Zdenka Hruskova, Zdenka Chocova, Johan Povlsen, Jon Gregersen, Per Ivarsen, Henrik Birn, Elizabeth Krarup, Erling B. Pedersen, Ingrid Thomsen, Jesper Nørgaard Bech, Wladmir Szpirt, Martin Egfjord, Rafik Mesbah, Pierre Bataille, Isabelle Rey, François Chantrel, Philipe Vanhille, Thomas Quémeneur
Abstract
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/1.73m 2 or more). Baseline eGFR was 21.7 ± 20.3 and 20.6 ± 18.7 ml/min/1.73m 2 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.