Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis
Identifieur interne : 006F01 ( Main/Exploration ); précédent : 006F00; suivant : 006F02Plasma exchange for renal vasculitis and idiopathic rapidly progressive glomerulonephritis: a meta-analysis
Auteurs : Michael Walsh [Canada, Royaume-Uni] ; Fausta Catapano [Royaume-Uni] ; Wladimir Szpirt [Danemark] ; Kristian Thorlund [Canada] ; Annette Bruchfeld [Suède] ; Loic Guillevin [France] ; Marion Haubitz [Allemagne] ; Peter A. Merkel [États-Unis] ; Chen Au Peh [Australie] ; Charles Pusey [Royaume-Uni] ; David Jayne [Royaume-Uni]Source :
- American journal of kidney diseases : the official journal of the National Kidney Foundation [ 0272-6386 ] ; 2010.
Abstract
Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized control trials of plasma exchange for renal vasculitis.
Systematic review and meta-analysis of manuscripts identified from electronic databases, bibliographies, and studies identified by experts. Data was abstracted in parallel by two reviewers.
Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis
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.
Adjuvant plasma exchange
Composite of end-stage renal disease or death.
We identified 9 trials including 387 patients. In a fixed-effects model the pooled relative risk of end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared to standard care alone (95% confidence interval 0.65 to 0.99; p=0.04). No significant heterogeneity was detected (p=0.5; I2=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 relative risk for end-stage renal disease was 0.64 (95% confidence interval 0.47 to 0.88; p=0.006) while the relative risk for death alone was 1.01 (95% confidence interval 0.71 to 1.4; p=0.9).
Although the primary result was statistically significant, there is insufficient statistical information to reliable determine if plasma exchange reduces the composite of end-stage renal disease or death.
Plasma exchange may reduce the composite endpoint of end-stage renal disease or death in renal vasculitis. Further trials are required given the limited data available.
Url:
DOI: 10.1053/j.ajkd.2010.10.049
PubMed: 21194817
PubMed Central: 3062650
Affiliations:
- Allemagne, Australie, Canada, Danemark, France, Royaume-Uni, Suède, États-Unis
- Angleterre, Basse-Saxe, Grand Londres, Hovedstaden, Massachusetts, Svealand, Île-de-France
- Boston, Copenhague, Hanovre, Londres, Paris, Stockholm
- Université Paris-Descartes
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Le document en format XML
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<author><name sortKey="Jayne, David" sort="Jayne, David" uniqKey="Jayne D" first="David" last="Jayne">David Jayne</name>
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<country xml:lang="fr">Royaume-Uni</country>
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<series><title level="j">American journal of kidney diseases : the official journal of the National Kidney Foundation</title>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P2">Plasma exchange may be effective adjunctive treatment for renal vasculitis. We performed a systematic review and meta-analysis of randomized control trials of plasma exchange for renal vasculitis.</p>
</sec>
<sec id="S2"><title>Study Design</title>
<p id="P3">Systematic review and meta-analysis of manuscripts identified from electronic databases, bibliographies, and studies identified by experts. Data was abstracted in parallel by two reviewers.</p>
</sec>
<sec id="S3"><title>Setting & Population</title>
<p id="P4">Adults with idiopathic renal vasculitis or rapidly progressive glomerulonephritis</p>
</sec>
<sec id="S4"><title>Selection Criteria for Studies</title>
<p id="P5">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.</p>
</sec>
<sec id="S5"><title>Intervention</title>
<p id="P6">Adjuvant plasma exchange</p>
</sec>
<sec id="S6"><title>Outcome</title>
<p id="P7">Composite of end-stage renal disease or death.</p>
</sec>
<sec id="S7"><title>Results</title>
<p id="P8">We identified 9 trials including 387 patients. In a fixed-effects model the pooled relative risk of end-stage renal disease or death was 0.80 for patients treated with adjunctive plasma exchange compared to standard care alone (95% confidence interval 0.65 to 0.99; p=0.04). No significant heterogeneity was detected (p=0.5; I<sup>2</sup>
=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 relative risk for end-stage renal disease was 0.64 (95% confidence interval 0.47 to 0.88; p=0.006) while the relative risk for death alone was 1.01 (95% confidence interval 0.71 to 1.4; p=0.9).</p>
</sec>
<sec id="S8"><title>Limitations</title>
<p id="P9">Although the primary result was statistically significant, there is insufficient statistical information to reliable determine if plasma exchange reduces the composite of end-stage renal disease or death.</p>
</sec>
<sec id="S9"><title>Conclusions</title>
<p id="P10">Plasma exchange may reduce the composite endpoint of end-stage renal disease or death in renal vasculitis. Further trials are required given the limited data available.</p>
</sec>
</div>
</front>
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<affiliations><list><country><li>Allemagne</li>
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<name sortKey="Pusey, Charles" sort="Pusey, Charles" uniqKey="Pusey C" first="Charles" last="Pusey">Charles Pusey</name>
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<country name="Danemark"><region name="Hovedstaden"><name sortKey="Szpirt, Wladimir" sort="Szpirt, Wladimir" uniqKey="Szpirt W" first="Wladimir" last="Szpirt">Wladimir Szpirt</name>
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<country name="Suède"><region name="Svealand"><name sortKey="Bruchfeld, Annette" sort="Bruchfeld, Annette" uniqKey="Bruchfeld A" first="Annette" last="Bruchfeld">Annette Bruchfeld</name>
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<country name="France"><region name="Île-de-France"><name sortKey="Guillevin, Loic" sort="Guillevin, Loic" uniqKey="Guillevin L" first="Loic" last="Guillevin">Loic Guillevin</name>
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<country name="Allemagne"><region name="Basse-Saxe"><name sortKey="Haubitz, Marion" sort="Haubitz, Marion" uniqKey="Haubitz M" first="Marion" last="Haubitz">Marion Haubitz</name>
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<country name="États-Unis"><region name="Massachusetts"><name sortKey="Merkel, Peter A" sort="Merkel, Peter A" uniqKey="Merkel P" first="Peter A." last="Merkel">Peter A. Merkel</name>
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<country name="Australie"><noRegion><name sortKey="Peh, Chen Au" sort="Peh, Chen Au" uniqKey="Peh C" first="Chen Au" last="Peh">Chen Au Peh</name>
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