Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis.

Abstract

BACKGROUND:

Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized controlled trials of plasma exchange for renal vasculitis.

STUDY DESIGN:

Systematic review and meta-analysis of articles identified from electronic databases, bibliographies, and studies identified by experts. Data were abstracted in parallel by 2 reviewers.

SETTING & POPULATION:

Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis.

SELECTION CRITERIA FOR STUDIES:

Randomized controlled trials that compared standard care with standard care plus adjuvant plasma exchange in adult patients with either renal vasculitis or idiopathic rapidly progressive glomerulonephritis.

INTERVENTION:

Adjuvant plasma exchange.

OUTCOME:

Composite of end-stage renal disease or death.

RESULTS:

We identified 9 trials including 387 patients. In a fixed-effects model, the pooled RR for end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared with standard care alone (95% CI, 0.65-0.99; P = 0.04). No significant heterogeneity was detected (P = 0.5; I(2) = 0%). The effect of plasma exchange did not differ significantly across the range of baseline serum creatinine values (P = 0.7) or number of plasma exchange treatments (P = 0.8). The RR for end-stage renal disease was 0.64 (95% CI, 0.47-0.88; P = 0.006), whereas the RR for death alone was 1.01 (95% CI, 0.71-1.4; P = 0.9).

LIMITATIONS:

Although the primary result was statistically significant, there is insufficient statistical information to reliably determine whether plasma exchange decreases the composite of end-stage renal disease or death.

CONCLUSIONS:

Plasma exchange may decrease the composite end point of end-stage renal disease or death in patients with renal vasculitis. Additional trials are required given the limited data available.

• Authors: Michael Walsh, Fausta Catapano, Wladimir Szpirt, Kristian Thorlund, Annette Bruchfeld, Loic Guillevin, Marion Haubitz, Peter A Merkel, Chen Au Peh, Charles Pusey, David Jayne
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 57 Issue 4 Pg. 566-74 (Apr 2011) ISSN: 1523-6838 [Electronic] United States
• PMID: 21194817 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (complications, therapy)
• Disease Progression
• Female
• Glomerulonephritis (etiology, therapy)
• Humans
• Kidney Failure, Chronic (epidemiology, mortality)
• Male
• Middle Aged
• Plasma Exchange
• Risk Factors
• Treatment Outcome