Early plasma exchange improves outcome in PR3-ANCA-positive renal vasculitis

Clin Exp Rheumatol. Jan-Feb 2012;30(1 Suppl 70):S39-47. Epub 2012 May 10.

Abstract

Objectives: Plasma exchange (PE) has been shown to improve renal outcome in anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) and severe renal failure; however the effect of PE in AAV with moderate renal impairment is controversial.

Methods: A single-centre, retrospective one-year follow-up study, including patients with renal AAV and eGFR <60 ml/min/1.73 m2. Since 2007, all patients with renal AAV and eGFR <60 ml/min/1.73 m2 had PE in addition to induction therapy with cyclophosphamide and prednisolone. Patients admitted from 1999 to 2007 that did not receive PE served as controls. The primary outcome was the combination of death, end-stage renal disease, and relapses after one year.

Results: A significant reduction in the primary endpoint was observed following the addition of PE (25% vs. 43%, p=0.04). Furthermore, a greater improvement in renal function after one year was observed among surviving PE treated patients not on dialysis (ΔeGFR 36.1 vs. 19.7 ml/min, p=0.03). There was a significant reduction in serious adverse events in the PE treated group (4% vs. 30%, p=0.02) despite no differences in types and doses of induction immunosuppressive therapy. The advantageous effect of PE was related to the presence of anti-proteinase3 (PR3)-antibodies and also evident among patients with plasma creatinine less than 500 μM.

Conclusions: This study suggests the use of PE in addition to standard induction treatment with cyclophosphamide and glucocorticoids to patients with renal PR3-AAV and an estimated-GFR <60 ml/min/1.73m2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / blood
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / complications
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / mortality
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / therapy*
  • Antibodies, Antineutrophil Cytoplasmic / blood*
  • Biomarkers / blood
  • Biopsy
  • Combined Modality Therapy
  • Creatinine / blood
  • Cyclophosphamide / therapeutic use
  • Denmark
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kaplan-Meier Estimate
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / prevention & control
  • Male
  • Middle Aged
  • Myeloblastin / immunology*
  • Plasma Exchange* / adverse effects
  • Plasma Exchange* / mortality
  • Prednisolone / therapeutic use
  • Recurrence
  • Renal Dialysis
  • Renal Insufficiency / blood
  • Renal Insufficiency / etiology
  • Renal Insufficiency / immunology
  • Renal Insufficiency / mortality
  • Renal Insufficiency / physiopathology
  • Renal Insufficiency / therapy*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Antibodies, Antineutrophil Cytoplasmic
  • Biomarkers
  • Immunosuppressive Agents
  • Cyclophosphamide
  • Prednisolone
  • Creatinine
  • Myeloblastin