title: 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.
  
  
  OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.affiliation: Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Solar-Cafaggi
authors.affiliation: Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
authors.forename: Yemil
authors.initials: Y
authors.lastname: Atisha-Fregoso
authors.affiliation: Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. andreaha@yahoo.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hinojosa-Azaola
mesh_terms: D056648:Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D014890:Granulomatosis with Polyangiitis / Q000401:mortality / Q000628:therapy; D006801:Humans; D055953:Microscopic Polyangiitis / Q000401:mortality / Q000628:therapy; D010956:Plasmapheresis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: ANCA; granulomatosis with polyangiitis; microscopic polyangiitis; plasma exchange