title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis.
  
  
  METHODS
  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.
  
  
  METHODS
  Adjuvant plasma exchange.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada. lastwalsh1975@gmail.com
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
authors.forename: Fausta
authors.initials: F
authors.lastname: Catapano
authors.forename: Wladimir
authors.initials: W
authors.lastname: Szpirt
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorlund
authors.forename: Annette
authors.initials: A
authors.lastname: Bruchfeld
authors.forename: Loic
authors.initials: L
authors.lastname: Guillevin
authors.forename: Marion
authors.initials: M
authors.lastname: Haubitz
authors.forename: Peter A
authors.initials: PA
authors.lastname: Merkel
authors.forename: Chen Au
authors.initials: CA
authors.lastname: Peh
authors.forename: Charles
authors.initials: C
authors.lastname: Pusey
authors.forename: David
authors.initials: D
authors.lastname: Jayne
mesh_terms: D000328:Adult; D000368:Aged; D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000150:complications / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012307:Risk Factors; D016896:Treatment Outcome