Odler Balazs, Riedl Regina, Geetha Duvuru, Szpirt Wladimir M, Hawley Carmel, Uchida Lisa, Wallace Zachary S, Walters Giles, Muso Eri, Tesar Vladimir, Pusey Charles D, Little Mark A, Merkel Peter A, Walsh Michael, Jayne David R W, Kronbichler Andreas
Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; Department of Medicine, University of Cambridge, Cambridge, UK.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
Kidney Int. 2025 Mar;107(3):558-567. doi: 10.1016/j.kint.2024.11.029. Epub 2024 Dec 19.
Therapeutic plasma exchange (PLEX) is an adjunctive treatment for patients with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis and kidney involvement. Little is known about the effect of PLEX on early changes in kidney function. This post-hoc analysis of the PEXIVAS trial investigated the effects of PLEX on changes in kidney function within 12 months. PEXIVAS was a randomized controlled trial recruiting 691 patients with ANCA-associated glomerulonephritis, of whom 349 underwent PLEX and 342 received no-PLEX. The primary outcomes of this post hoc study of PEXIVAS were change in estimated glomerular filtration rate (eGFR) from baseline and recovery of kidney function (defined as eGFR increase of 15ml/min/1.73m or more). Baseline eGFR was 21.7 ± 20.3 and 20.6 ± 18.7 ml/min/1.73m in the PLEX and no-PLEX groups, respectively. Mean improvements in eGFR at weeks two, four, and eight after initiation of therapy were greater for the PLEX vs. the no-PLEX groups. The greatest significant difference in recovery of kidney function in the PLEX compared to the no-PLEX groups was at week four (relative risk (RR): 1.41; 95% confidence interval:1.09-1.82). Increased eGFR or recovery of kidney function at week four were significantly associated with lower risk for end-stage kidney disease at week 52 (RR: 0.96: 0.95-0.97, and RR: 0.29: 0.16-0.52; respectively). Neither changes in eGFR nor recovery of kidney function differed by reduced- compared to standard-dose glucocorticoid group. Overall, our study indicates that PLEX improves early kidney function in patients with ANCA-associated glomerulonephritis.
治疗性血浆置换（PLEX）是抗中性粒细胞胞浆抗体（ANCA）相关性血管炎合并肾脏受累患者的一种辅助治疗方法。关于PLEX对肾功能早期变化的影响，目前所知甚少。这项对PEXIVAS试验的事后分析研究了PLEX对12个月内肾功能变化的影响。PEXIVAS是一项随机对照试验，招募了691例ANCA相关性肾小球肾炎患者，其中349例接受了PLEX治疗，342例未接受PLEX治疗。PEXIVAS这项事后研究的主要结局是估计肾小球滤过率（eGFR）相对于基线的变化以及肾功能恢复情况（定义为eGFR增加15ml/min/1.73m²或更多）。PLEX组和非PLEX组的基线eGFR分别为21.7±20.3和20.6±18.7ml/min/1.73m²。与非PLEX组相比，PLEX组在治疗开始后第2周、第4周和第8周时eGFR的平均改善更大。与非PLEX组相比，PLEX组在肾功能恢复方面的最大显著差异出现在第4周（相对风险（RR）：1.41；95%置信区间：1.09 - 1.82）。第4周时eGFR增加或肾功能恢复与第52周时终末期肾病风险较低显著相关（RR分别为：0.96：0.95 - 0.97和RR：0.29：0.16 - 0.52）。与标准剂量糖皮质激素组相比，减量糖皮质激素组的eGFR变化和肾功能恢复情况均无差异。总体而言，我们的研究表明，PLEX可改善ANCA相关性肾小球肾炎患者的早期肾功能。
