In the entire study population, plasma exchange (PLEX) was not linked with a better primary outcome [defined as mortality or KRT at 12 months (M12)], however, a subset of patients with ANCA-associated vasculitides (AAV) was unveiled for whom PLEX could be beneficial. These results require validation before being utilized in clinical decision making.

• Role of PLEX in AAV was challenged by the data from the PEXIVAS trial.

• This is a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX.

• PLEX did not significantly benefit the primary outcome.

• A prediction model showed better predicted outcome with PLEX vs without PLEX in 223 patients; of these, 177 exhibited >5% elevated predicted likelihood with PLEX vs 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 found to be significantly lower with PLEX in the PLEX-recommended group vs the PLEX not recommended group.

• In the PLEX-recommended group, more frequent were microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score.

• Cases for whom PLEX would be beneficial were found via an easy to use score.

• Average treatment impact of PLEX for those with recommended treatment corresponded to an absolute risk decrease for death or KRT at M12 of 24.6%.