Plasmapheresis therapy in ANCA-associated vasculitides: A single-center retrospective analysis of renal outcome and mortality.

Abstract

BACKGROUND:

The evidence of the benefit of plasmapheresis in renal and survival outcomes in patients with severe manifestations of ANCA-associated vasculitides is inconsistent.

PURPOSE:

To address whether plasmapheresis is associated with improvement in renal function and survival at 12 months in patients with severe manifestations of ANCA-associated vasculitides.

PATIENTS AND METHODS:

Single-center retrospective comparative cohort of 24 patients with granulomatosis with polyangiitis or microscopic polyangiitis that received plasmapheresis adjunctive to conventional therapy (steroids and immunosuppressants), matched 1:1 according to age, estimated glomerular filtration rate (eGFR) and disease activity with 24 patients treated with standard treatment only. Comorbidities, demographic, clinical, treatment and laboratory characteristics were recorded.

RESULTS:

After 12 months both groups showed improvement in eGFR (19.0 ± 14.34 to 41.61 ± 37.77 ml/min, p = 0.003 in plasmapheresis group; 23.16 ± 14.71 to 39.86 ± 25.67 ml/min, p = 0.001 in conventional therapy group). No differences were found between groups (p = 0.68). Patients free of dialysis at 12 months after intervention increased in the plasmapheresis group from 9/24 (38%) to 12/24 (50%), p = 0.5; and in the conventional therapy group from 19/24 (79%) to 22/24 (92%), p = 0.25. Difference between groups was significant at 12 months (p = 0.001). Survival at 12 months after intervention was 79% in the plasmapheresis group and 96% in the conventional therapy group (p = 0.08). The main cause of death was infectious and a tendency for a higher prevalence of severe infections was observed in patients that received plasmapheresis (p = 0.07).

CONCLUSION:

Both plasmapheresis and conventional therapy improved eGFR at 12 months after intervention. Dialysis independence and survival were similar between groups. J. Clin. Apheresis 31:411-418, 2016. © 2015 Wiley Periodicals, Inc.

• Authors: David Solar-Cafaggi, Yemil Atisha-Fregoso, Andrea Hinojosa-Azaola
• Journal: Journal of clinical apheresis (J Clin Apher) Vol. 31 Issue 5 Pg. 411-8 (Oct 2016) ISSN: 1098-1101 [Electronic] United States
• PMID: 26194633 (Publication Type: Journal Article)
• Copyright: © 2015 Wiley Periodicals, Inc.

Topics

• Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis (mortality, therapy)
• Case-Control Studies
• Glomerular Filtration Rate (drug effects)
• Granulomatosis with Polyangiitis (mortality, therapy)
• Humans
• Microscopic Polyangiitis (mortality, therapy)
• Plasmapheresis (adverse effects, mortality)
• Retrospective Studies
• Survival Rate
• Treatment Outcome