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Kidney histopathology can predict kidney function in ANCA-associated vasculitides with acute kidney injury treated with plasma exchanges

Journal of the American Society of Nephrology Feb 02, 2022

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%.

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