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Plasma exchange in ANCA-associated vasculitis : the pro position

Kronbichler, Andreas ; Shin, Jae Il ; Wang, Chia Shi ; Szpirt, Wladimir M. ; Segelmark, Mårten LU and Tesar, Vladimir (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
; ; ; ; and
organization
publishing date
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
2024-06-13 07:12:32
@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 &lt;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}},
}