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Plasma exchange in ANCA-associated vasculitis: the pro position

Authors
 Andreas Kronbichler  ;  Jae Il Shin  ;  Chia-Shi Wang  ;  Wladimir M Szpirt  ;  Mårten Segelmark  ;  Vladimir Tesar 
Citation
 NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol.36(2) : 227-231, 2021-01 
Journal Title
 NEPHROLOGY DIALYSIS TRANSPLANTATION 
ISSN
 0931-0509 
Issue Date
2021-01
Keywords
ANCA ; alveolar haemorrhage ; extracorporeal therapy ; plasma exchange ; renal recovery
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 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.
Full Text
https://academic.oup.com/ndt/article/36/2/227/6055048
DOI
10.1093/ndt/gfaa311
Appears in Collections:
1. College of Medicine (의과대학) > Others (기타) > 1. Journal Papers
Yonsei Authors
Shin, Jae Il(신재일) ORCID logo https://orcid.org/0000-0003-2326-1820
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182382
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