Plasma exchange in ANCA-associated vasculitis : the pro position
(2021) In Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 36(2). p.227-231- Abstract
Plasma exchange (PLEX) is capable of removing significant amounts of circulating antibodies. In anti-neutrophil cytoplasmic antibody-associated vasculitis, PLEX was reserved for patients with severe presentation forms such as rapidly progressive glomerulonephritis and pulmonary haemorrhage. The Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis (PEXIVAS) trial included all comers with a glomerular filtration rate <50 mL/min/1.73 m2 and thus aimed to answer the question of whether PLEX is an option for patients with no relevant kidney function impairment or not. PEXIVAS revealed that after a follow-up of almost 3 years, routine administration of PLEX does not provide an additional benefit to reduce the rate of a... (More)
Plasma exchange (PLEX) is capable of removing significant amounts of circulating antibodies. In anti-neutrophil cytoplasmic antibody-associated vasculitis, PLEX was reserved for patients with severe presentation forms such as rapidly progressive glomerulonephritis and pulmonary haemorrhage. The Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis (PEXIVAS) trial included all comers with a glomerular filtration rate <50 mL/min/1.73 m2 and thus aimed to answer the question of whether PLEX is an option for patients with no relevant kidney function impairment or not. PEXIVAS revealed that after a follow-up of almost 3 years, routine administration of PLEX does not provide an additional benefit to reduce the rate of a composite comprising end-stage kidney disease or death. In the absence of histological parameters, it is tempting to speculate whether PLEX is effective or not in those with a potential for renal recovery. A subset of patients presented with alveolar haemorrhage, and there was a trend towards a better outcome of such cases receiving PLEX. This would be in line with observational studies reporting a recovery of alveolar haemorrhage following extracorporeal treatment. In this PRO part of the debate, we highlight the shortcomings of the PEXIVAS trial and stimulate further research paths, which in our eyes are necessary before abandoning PLEX from the therapeutic armamentarium.
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- author
- Kronbichler, Andreas ; Shin, Jae Il ; Wang, Chia Shi ; Szpirt, Wladimir M. ; Segelmark, Mårten LU and Tesar, Vladimir
- organization
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- alveolar haemorrhage, ANCA, extracorporeal therapy, plasma exchange, renal recovery
- in
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
- volume
- 36
- issue
- 2
- pages
- 5 pages
- publisher
- Oxford University Press
- external identifiers
-
- scopus:85100445546
- pmid:33374018
- ISSN
- 1460-2385
- DOI
- 10.1093/ndt/gfaa311
- language
- English
- LU publication?
- yes
- id
- 4d7193df-18c4-46d5-b760-55e1aad6ce62
- date added to LUP
- 2021-02-18 10:03:32
- date last changed
- 2024-09-19 16:25:10
@article{4d7193df-18c4-46d5-b760-55e1aad6ce62, abstract = {{<p>Plasma exchange (PLEX) is capable of removing significant amounts of circulating antibodies. In anti-neutrophil cytoplasmic antibody-associated vasculitis, PLEX was reserved for patients with severe presentation forms such as rapidly progressive glomerulonephritis and pulmonary haemorrhage. The Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis (PEXIVAS) trial included all comers with a glomerular filtration rate <50 mL/min/1.73 m2 and thus aimed to answer the question of whether PLEX is an option for patients with no relevant kidney function impairment or not. PEXIVAS revealed that after a follow-up of almost 3 years, routine administration of PLEX does not provide an additional benefit to reduce the rate of a composite comprising end-stage kidney disease or death. In the absence of histological parameters, it is tempting to speculate whether PLEX is effective or not in those with a potential for renal recovery. A subset of patients presented with alveolar haemorrhage, and there was a trend towards a better outcome of such cases receiving PLEX. This would be in line with observational studies reporting a recovery of alveolar haemorrhage following extracorporeal treatment. In this PRO part of the debate, we highlight the shortcomings of the PEXIVAS trial and stimulate further research paths, which in our eyes are necessary before abandoning PLEX from the therapeutic armamentarium.</p>}}, author = {{Kronbichler, Andreas and Shin, Jae Il and Wang, Chia Shi and Szpirt, Wladimir M. and Segelmark, Mårten and Tesar, Vladimir}}, issn = {{1460-2385}}, keywords = {{alveolar haemorrhage; ANCA; extracorporeal therapy; plasma exchange; renal recovery}}, language = {{eng}}, number = {{2}}, pages = {{227--231}}, publisher = {{Oxford University Press}}, series = {{Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association}}, title = {{Plasma exchange in ANCA-associated vasculitis : the pro position}}, url = {{http://dx.doi.org/10.1093/ndt/gfaa311}}, doi = {{10.1093/ndt/gfaa311}}, volume = {{36}}, year = {{2021}}, }