Dorian Nezam1, Raphaël Porcher2, François Grolleau2, Pauline Morel3, Dimitri Titeca-Beauport4, Stanislas Faguer5, Alexandre Karras6, Justine Solignac7, Noémie Jourde-Chiche7, François Maurier8, Hamza Sakhi9,10, Khalil El Karoui9,10, Rafik Mesbah11, Pierre Louis Carron12, Vincent Audard9,10, Didier Ducloux13, Romain Paule14, Jean-François Augusto15, Julien Aniort16, Aurélien Tiple17, Cédric Rafat18, Séverine Beaudreuil19, Xavier Puéchal20, Pierre Gobert21, Ziad Massy22, Catherine Hanrotel23, Stéphane Bally24, Nihal Martis25, Cécile-Audrey Durel26, Geoffroy Desbuissons27, Pascal Godmer28, Aurélie Hummel29, François Perrin30, Antoine Néel31, Claire De Moreuil32, Tiphaine Goulenok33, Dominique Guerrot1, Steven Grange34, Aurélie Foucher35, Alban Deroux36, Carole Cordonnier37, Céline Guilbeau-Frugier38, Anne Modesto-Segonds38, Dominique Nochy39, Laurent Daniel40, Anissa Moktefi41, Marion Rabant42, Loïc Guillevin20, Alexis Régent20, Benjamin Terrier43. 1. Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France. 2. Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France. 3. Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France. 4. Service de Néphrologie, CHU Amiens Picardie, Amiens, France. 5. Département de Néphrologie et Transplantation d'organes, Hôpital Rangueil, Toulouse, France. 6. Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France. 7. Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France. 8. Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France. 9. Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France. 10. Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France. 11. Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France. 12. Service de Néphrologie, Hôpital Nord, CHU Grenoble, Grenoble, France. 13. Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France. 14. Service de Médecine Interne, Hôpital Foch, Suresnes, France. 15. Service de Néphrologie, Dialyse, Transplantation, CHU, CHU Angers, Angers, France. 16. Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France. 17. Service de Néphrologie, CHU Jacques Lacarin, Vichy, France. 18. Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France. 19. Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France. 20. Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France. 21. Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France. 22. Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France. 23. Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France. 24. Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France. 25. Service de Médecine Interne, CHU Nice, France. 26. Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France. 27. Service de Néphrologie, Hôpitaux Privés de l'ouest Parisien, Trappes, France. 28. Service de Médecine Interne, CHBA site de Vannes, Vannes, France. 29. Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France. 30. Service de Médecine Interne, CHU de Saint-Nazaire, France. 31. Service de Médecine Interne, CHU de Nantes, France. 32. Service de Médecine Interne, CHRU de Brest, France. 33. Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France. 34. Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France. 35. Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France. 36. Service de Médecine Interne, CHU de Grenoble, France. 37. Service d'anatomie et de cytologie pathologiques, Hôpital Nord, CHU d'Amiens, France. 38. Service d'anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France. 39. Service d'Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France. 40. Service d'Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France. 41. Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France. 42. Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France. 43. Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France benjamin.terrier@aphp.fr.
Abstract
BACKGROUND: Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS: We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS: No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS: PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
BACKGROUND: Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS: We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS: No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS: PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Authors: Silke R Brix; Mercedes Noriega; Pierre Tennstedt; Eik Vettorazzi; Martin Busch; Martin Nitschke; Wolfram J Jabs; Fedai Özcan; Ralph Wendt; Martin Hausberg; Lorenz Sellin; Ulf Panzer; Tobias B Huber; Rüdiger Waldherr; Helmut Hopfer; Rolf A K Stahl; Thorsten Wiech Journal: Kidney Int Date: 2018-10-29 Impact factor: 10.612
Authors: Alvise Berti; Emilie Cornec-Le Gall; Divi Cornec; Marta Casal Moura; Eric L Matteson; Cynthia S Crowson; Aishwarya Ravindran; Sanjeev Sethi; Fernando C Fervenza; Ulrich Specks Journal: Nephrol Dial Transplant Date: 2019-09-01 Impact factor: 5.992
Authors: Marta Casal Moura; Maria José Soler; Sanjeev Sethi; Fernando C Fervenza; Ulrich Specks Journal: J Am Soc Nephrol Date: 2022-04-11 Impact factor: 14.978